27Apr

Article Summary: Home With An NG Tube?

By Laura Madlinger Lews, OTD, OTR/L, CNT

You arrive in the NICU early Monday morning to see your first patient. Liza is an ex 28 weeker, who is now 40 weeks. She is stable on room air, and the only reason she remains in the NICU is feeding, which continues to slowly improve. Liza starts to fuss just before her scheduled feeding time. You watch as her mom offers her a bottle. Mom positions her in an elevated sidelying position and uses a bottle with an appropriate flow rate for her baby. Liza feeds with good quality but falls asleep before finishing the last 15 ccs. She is so close, but just does not have the endurance to finish all her bottles. Her family is patient with her, while also longing for the day that she can come home. They have wondered out loud if Liza may feed better at home than in the NICU. Could she be discharged with an NG tube and continue to work on oral feeding at home? Is this possible? Safe? What does recent evidence suggest?

A soon to be published prospective cohort study sought to compare healthcare utilization and parent health-related quality of life in infants whose discharge was delayed by oral feeding. The study analyzed outcomes of 180 infants: 80 at full oral feeds, 35 using NG tubes, and 65 using g-tubes. Infants were considered eligible for home NG tube if they were > 36 weeks PMA, > 2 kilos, 5 days free of apnea and bradycardia requiring intervention after discontinuation of caffeine, had stable temperature in open crib for 2 days, were receiving home respiratory support (either room air, < 0.5 liter per minute nasal cannula), taking at least 25% of feedings by mouth, had age-appropriate weight gain, and were without anatomic anomalies precluding NG tube placement. Of note, this institution uses a bridle to secure NG tubes prior to discharge to decrease risk of the tube becoming dislodged and reduce need for caregiver training for placement.

At 3 months post-discharge, 77% of infants discharged on NG tube feedings had reached full oral feedings, with a median of 29 days of NG use. Infants with g-tubes had a higher proportion of acute healthcare encounters (tube replacement, site bleeding or infection, failure to thrive, poor weight gain or feeding difficulties). There were “relatively few feeding or tube-related encounters in the oral and NG tube feeding groups.” Researchers estimate saving a cumulative 1574 NICU days by utilizing a home NG program. Additionally, if this NICU had discharged all home NG eligible infants at 40 weeks PMA in addition to the actual home NG patients, 1679 NICU days would have been saved. In terms of parental outcomes, parent health-related quality of life did not differ between groups, but parents of infants discharged with NG tubes reported feeling well-prepared to care for their infants at home.

Researchers highlighted that consistent follow up with a multi-disciplinary team (GI nurse practitioner, dietician, and speech therapist for their program) was crucial for all tube fed infants. Though there are many benefits of infants being discharged from the NICU sooner, researchers note that families then do not have daily access to therapy as they would in the hospital. Thus, a follow up plan is critical.

Does your unit discharge infants with NG tubes? What is therapy’s role in helping to determine who could be a good candidate? What is the plan for follow up?

To access the abstract of the study (or full text of journal pre-proof for subscribers), visit ScienceDirect’s website link here.

Lagatta, J., Uhing, M., Acharya, K., Lavoie, J., Rholl, E., Malin, K., et al. (2021). Actual and potential impact of a home nasogastric tube feeding program for Infants whose NICU discharge is affected by delayed oral feedings. Journal of Pediatrics.

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