PC1116: Predictive Factors for Avoiding Eventual Gastrostomy Tube Placement in Infants Discharged from the NICU on Nasogastric Tube Feeds

Background: Feeding difficulties are common in infants treated in the neonatal intensive care unit (NICU) and often persist at discharge. Partial or complete nutrition may be necessary through an enteral tube such as nasogastric (NG) or gastrostomy tube (GT). NG feeding after NICU discharge is safe, but possible need for surgical GT placement remains. The purpose of our study was to evaluate infants discharged with NG feeds to determine predictive factors associated with attaining complete oral feeding vs. eventual requirement of a GT and the effect on hospital resource utilization.

Methods: A single center retrospective cohort study was performed of the 187 infants discharged on NG feeding from a level IV NICU from 2012-2018. Infants were analyzed according to achievement of oral enteral autonomy vs. progression to surgical GT placement within a year after NICU discharge. Primary endpoints were hospital resource utilization in the form of emergency department (ED) visits or hospital readmissions.

Results: The majority of infants gained enteral autonomy within a year after NICU discharge 143 (76%) vs. 44 (24%). Patients that eventually underwent surgical GT were tolerating less oral intake at discharge (8% vs. 22%, p=0.001) and fewer of them were on bolus NG feeds at discharge (59% vs. 85%, p=0.001). They were more likely to require home oxygen supplementation (39% vs 21%, p=0.008) and more likely to have pulmonary and genetic comorbidities (Table 1). Infants that progressed to GT were significantly more likely to have any ED visits and hospital readmissions (Figure 1). In addition, infants that progressed to GT had significantly more mean ED visits (2.05 vs 0.46, p< 0.001) and hospital readmissions (0.70 vs 0.10, p< 0.001) per infant.

Conclusion: A substantial portion of infants discharged with NG access were able to achieve complete oral nutritional autonomy within a year after NICU discharge. Predictive factors may exist to help guide decision making regarding need for GT before NICU discharge vs. discharge on NG feeds. This can significantly affect hospital resource utilization and can provide improved value-based care.