Lisa McGill-Vargas, MD and Ron Ilg, MD
Sacred Heart Children’s Hospital
One of the most difficult hurdles for premature infants or infants born with complex medical conditions is developing the ability to safely nipple feed. Recent focus on early family-centered care, developmental interventions, and feeding protocols has been helping high-risk babies achieve the skill at an earlier time.1,2 Nevertheless, many infants face the possibility of a temporary gastrostomy tube or an extended hospital stay as they transition from nasogastric feeds to independent feeding.
Another possible option is home nasogastric (NG) feeds. Home NG feeding allows the final transition to full oral intake after the infant is discharged. This allows babies to be reunited with their families, encourages breastfeeding and reduces healthcare and family costs.
In 2016, Sacred Heart Children’s Hospital NICU implemented a quality improvement initiative to standardize discharge home with NG feeds. In addition to specific patient criteria, all infants discharged home with NG feeds had access to home health services and an outpatient feeding clinic.
Data was collected tracking complications and parent satisfaction. A parent survey was completed for 32 infants. The survey showed home NG feeds was rated positively by this group of parents (Figure 1).
The range of NG tube duration was from 0 to 100+ days, with the majority between 1 to 15 days (Figure 2). There were no hospital or ER visits related to NG feeding complications. Only two patients (6%) required subsequent gastrostomy tube placement.
Feeding is a complex and physically challenging process for high-risk infants and the process can be stressful for parents. For some families, home NG feeds offers a safe alternative to a continued hospitalization. It helps to alleviate parental anxiety and facilitates an earlier, safe, discharge home. Further evaluation and studies examining a multidisciplinary, standardized approach to infant feeding, and the coordination for safe discharge home on NG feeds, as well as long-term follow-up and support is needed.
Figure 1. Parent rating of satisfaction with home NG
Figure 2. Duration of home NG requirement
- Gianni ML, Sannino P, Bezze E, et al. Does parental involvement affect the development of feeding skills in preterm infants? A prospective study. Early Human Development 2016; 103:123-128. 1
- Wellington A, Perlman JM. Infant-driven feeding in premature infants: a quality improvement project. Arch. Dis. Child. Fetal Neonatal Ed. 2015;100:F495-F500