Home Nasogastric Tube Feeding in Patients with Traditional Indications for Gastrostomy Tube Placement

Abstract

<i>Background</i>: Gastrostomy tube placement (GTP) has become standard of care in infants with esophageal atresia, severe neurologic impairment, evidence of severe dysphagia with aspiration, and tracheostomy; all other indications are considered non-traditional indications with little evidence of benefit. <i>Objective</i>: The aim of the study is to identify a select group of infants with non- traditional indications for GTP who may benefit from home nasogastric feeds (HNGF) with a pre-established protocol and algorithm. <i>Methods</i>: We performed a retrospective study of all infants who underwent GTP between January 2015 and December 2017. Infants were categorized as having traditional or non-traditional indications for GTP. Parents or designated caregivers were prospectively contacted by phone and interviewed to determine gastrostomy tube (GT) use status, time to full per oral (PO) feeds, and related complications after discharge. <i>Results</i>: 111 infants had GTP during the study period and 51 (46%) of these were classified as non-traditional indications: term infants with chronic oral aversion, preterm infants with mild to moderate dysphagia, infants of diabetic mothers with feeding problems, post-op cardiac patients with oral aversion, and patients with isolated Pierre Robin sequence. The average days of PO trial before GTP in this group was 41 (±30.5) days, average oral intake and average age at GTP was 32% and 75±42.4 days respectively. Average duration of GT use was 403.4±390.7 days. After discharge, 100% of preterm infants with oral aversion or dysphagia, 100% of infants with isolated Pierre Robin sequence, and 75% of infants of diabetic mothers reached full feeds by mouth in less than 90 days. Only 30% of infants with complex congenital heart defects met this goal. Thirty percent of infants with mild to moderate aspiration reached full PO feeds on average at 22.5 months post-conception age. All infants with neurodevelopmental abnormalities and feeding problems were still on GT feeds at the time of parental interview. <i>Conclusion</i>: We identified a cohort of infants with non-traditional indications for GTP who may benefit from HNGF. Future quality improvement initiatives and randomized controlled studies with HNGF should include infants with the probability of reaching full feeds before 6 months of life to avoid the complications and costs associated with GT placement.