Impact of NG Feeding Program for NICU Graduates

A recent prospective cohort study (JM Lagatta et al. J Pediatr 2021; 234: 38-45. Full text: Actual and Potential Impact of a Home Nasogastric Tube Feeding Program for Infants Whose Neonatal Intensive Care Unit Discharge Is Affected by Delayed Oral Feedings) shows that an NG home feeding program can get infants home sooner without tube-related readmissions.

The abstract, in my view, makes a mistake by emphasizing that NG fed infants (n=35) had less hospital readmissions and ED encounters than G-tube fed infants (n=65). This is problematic because infants who received G-tubes were much sicker than NG fed infants (see Table 1). Compared to NG patients, G-tube patients were more premature (32% 22-28 weeks vs 20% for NG), lower birthweight (2510 g vs 1664 g), more chromosomal anomalies (suspected & confirmed 38% vs. 23%), more likely to have abnormal brain imaging (32% vs 20%), and more likely to have a tracheostomy (34% vs. 0%). In addition, as noted below, the institution reports a very high rate of G-tube dislodgement.

Key points (in my view):

  • “Our institution uses a a bridle to secure NG tubes just before NICU discharge”
  • The authors delineate specific criteria for NG discharge: “at least 36 weeks of postmenstrual age (PMA) and weight of 2 kg; 5 days free of apnea or bradycardia requiring nursing intervention after discontinuation of caffeine; 2 days of temperature stability in an open crib; receiving home respiratory support (either room air, or at or below 0.5 liters per minute nasal cannula); at least 25% of feedings by mouth; age-appropriate weight gain; and without anatomic anomalies precluding NG tube placement”
  • By 3 months after NICU discharge, 27 of 35 (77%) infants discharged with NG tubes had progressed to full oral feeds; of the remaining 8 infants, 3 received G tubes during the study period, and an additional 3 were scheduled to receive a G tube”
  • Median duration of NG use was 29 days. The discussion notes that discharge to home may facilitate quicker weaning from NG tubes (SL Williams et al. Tube feeding outcomes of infants in a Level IV NICU.J Perinatol. 2019; 39: 1406-1410)
  • The authors report a very high rate of G-tube dislodgement, 19 of 65, in a 3-month period. This point is not analyzed by the authors but suggests that the institution utilizes a G-tube prone to dislodgement (eg. secured by a balloon).

My take: This article makes two key points: 1. An NG feeding program can help get infants home sooner and safely (especially with bridle placement) 2. In their institution, G-tubes are dislodged a lot and this leads to frequent returns for medical care; this high rate of dislodgement may indicate a potential benefit to using a different type of G-tube.

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