Rates and Determinants of Home Nasogastric Tube Feeding in Infants Born Very Preterm.

OBJECTIVE: To examine rates and determinants of home nasogastric (NG)-tube feeding at hospital discharge in a cohort of very preterm infants within the Canadian Neonatal Network (CNN). STUDY DESIGN: This was a population-based cohort study of infants born <33 weeks of gestation and admitted to neonatal intensive care units (NICUs) participating in the CNN between January 1, 2010, and December 31, 2018. We excluded infants who had major congenital anomalies, required gastrostomy-tube, or were discharged to non-CNN facilities. Multivariable logistic regression analysis was used to identify independent determinants of home NG-tube feeding at hospital discharge. RESULTS: Among the 13 232 infants born very preterm during the study period, 333 (2.5%) were discharged home to receive NG-tube feeding. Rates of home NG-tube feeding varied across Canadian NICUs, from 0% to 12%. Determinants of home NG-tube feeding were gestational age (aOR 0.94 per each gestational week increase, 95% CI 0.88-0.99); duration of mechanical ventilation (aOR 1.02 per each day increase, 95% CI 1.01-1.02); high illness severity at birth (aOR 1.32, 95% CI 1.01-1.74); small for gestational age (aOR 2.06, 95% CI 1.52-2.78); male sex (aOR 0.61, 95% CI 0.49-0.77); severe brain injury (aOR 1.60, 95% CI 1.10-2.32); and bronchopulmonary dysplasia (aOR 2.22, 95% CI 1.67-2.94). CONCLUSIONS: Rates of home NG-tube feeding varied widely between Canadian NICUs. Higher gestational age and male sex reduced the odds of discharge home to receive NG-tube feeding; and in contrast small for gestational age, severe brain injury, prolonged duration on mechanical ventilation and bronchopulmonary dysplasia increased the odds.

Managing gastroesophageal reflux symptoms in the very low-birth-weight infant postdischarge.

Gastroesophageal reflux and gastroesophageal reflux disease symptoms are common challenges for very low-birth-weight infants (<1500 g). These symptoms frequently result in feeding difficulties and family stress. Management of symptoms across healthcare disciplines may not be based on current evidence, and inconsistency can result in confusion for families and delayed interventions. The feeding relationship between infant and caregivers may be impaired when symptoms are persistent and poorly managed. An algorithm for managing gastroesophageal reflux-like symptoms in very low-birth-weight infants (from hospital discharge to 12 months corrected age) was developed through the formation of a multidisciplinary community of practice and critical appraisal of the literature. A case study demonstrates how the algorithm results in a consistent approach for identifying symptoms, applying appropriate management strategies, and facilitating appropriate timing of medical consultation. Application to managing gastroesophageal reflux symptoms in the neonatal intensive care unit will be briefly addressed.

Making the literature palatable at the bedside: Reference poster promotes oral feeding best practice.

Neonatal nurses often draw upon prior experiences and intuition to feed neonates. Such experience and skill vary from nurse to nurse and may not be based on recent research, nor tailored to each neonate's feeding skill. An evidence-based neonatal oral feeding guideline was produced to improve oral feeding practices among nurses and parents. The implementation was initially less than ideal, resulting in poor compliance. A bedside reference poster was designed to serve as a visual succinct reminder of the oral feeding guideline.

An Interdisciplinary Feeding Team Approachfor Preterm, High-Risk Infants and Children.

Poor oral feeding abilities in high-risk infants and children require interdisciplinary assessment and treatment in relation to nutrition, growth, oral feeding skills, behavioural interactions, and family coping. This paper describes the Perinatal Feeding Team's experiences, the format of our assessments, and the frequency of interventions recommended for 33 patients referred over 18 months. The most frequent reasons for assessment were suspected oral sensorimotor dysfunction/disorganization, decreased growth velocity, and feeding skills delay (each 18.3%); aversive reactions to feeding (14%) and significant parental stress around feedings (13.3%). Preassessment tools facilitated identification of relevant feeding problems. The dietitian, occupational therapist, psychologist, and parents played specific roles in providing a comprehensive feeding assessment. Interventions most frequently recommended were nutrition counselling (97%), food texture and feeding skill progression (90.9%), and normalizing sensorimotor function (84.8%). These findings led to the development of the Oral Eating Readiness Assessment List (ORAL(c)). Coordinated care plans are individualized and prioritized with parents. Our collaborative approach to multifaceted feeding difficulties in a follow-up clinic for preterm, high-risk children continues to evolve as we learn more about the needs of these children and their families.