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

Indira Chandrasekar; Erica Ortiz; Jennifer Norgaard; Mario Augusto Rojas

doi:doi:10.11648/j.ijg.20210502.19

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

Indira Chandrasekar, Erica Ortiz, Jennifer Norgaard, Mario Augusto Rojas

Published in International Journal of Gastroenterology (Volume 5, Issue 2)

Received: 1 October 2021 Accepted: 26 October 2021 Published: 3 December 2021

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Abstract

Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusion: 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.

Published in	International Journal of Gastroenterology (Volume 5, Issue 2)
DOI	10.11648/j.ijg.20210502.19
Page(s)	91-95
Creative Commons	This is an Open Access article, distributed under the terms of the Creative Commons Attribution 4.0 International License (http://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution and reproduction in any medium or format, provided the original work is properly cited.
Copyright	Copyright © The Author(s), 2024. Published by Science Publishing Group

Keywords

Gastrostomy Tube Placement, Home Nasogastric Feeds, Neonates

References

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[2]	Lidsky ME, Lander TA, Sidman JD. Resolving feeding difficulties with early airway intervention in Pierre Robin sequence. The laryngoscope 2008. 118: 120-123.
[3]	Rossi AF, Fishberger S, Hannan RL, et al. Frequency and indications for trachesotomy and gastrostomy after congenital heart surgery. Pediatric Cardiol 2009: 30 (3): 225-231.
[4]	Ramelli GP, Aloysius A, et al. Gastrostomy placement in pediatric patients with neuromuscular disorders: indications and outcome. Develop med & child Neurol. 2007; 49 (5): 367-71.
[5]	Greene NH, Greenberg RG, O'Brien SM, et al. Variation in Gastrostomy Tube Placement in Premature Infants in the United States. Am J Perinatol. 2019; 36 (12): 1243-1249. doi: 10.1055/s-0038-1676591.
[6]	Bromiker R, Rachamim A, Hammerman C et al. Immature sucking patterns in infants of mothers with diabetes. J Pediatr 2006; 149: 640–643.
[7]	Haws EB, Sieber WK, Kiesewetter WB. Complications of Tube Gastrostomy in Infants and Children- 15 year Review of 240 cases. Annals of Surg Aug 1966; 284-290.
[8]	Naiditch JA, lautz T, Barsness KA. Postoperative complications in children undergoing gastrostomy tube placement. J Laproendoscopic & advanced surg techniques. 2010; 20: 781-85.
[9]	Conner R. G, and Sealy, W. C: Gastrostomy and Its Complications. Ann. Surg., 1956; 143 (2): 245–250.
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[15]	Bathie J, Shaw J (2013) Early discharge home from the neonatal unit with support of naso-gastric tube feeding. J Neonatal Nurs 19: 213-216.
[16]	Nzirawa T (2017) Early Discharge from the Neonatal Unit with Nasogastric Tube Feeding: Does not Mean Isolated Working. J Perioper Crit Intensive Care Nurs 3: 136. doi: 10.4172/2471-9870.1000136.
[17]	Pemberton J, Frankfurter C, Bailey K, Jones L, Walton JM. Gastrostomy matters—the impact of pediatric surgery on caregiver quality of life. J Pediatr Surg 2013; 48: 963-70.
[18]	Dickson A, Clarke M, Tawfik R, Thomas AG. Caregivers’ perceptions following gastrostomy in severely disabled children with feeding problems. Dev Med Child Neurol 2008; 39: 746-51.
[19]	Spalding K, McKeever P. Mothers’ experiences caring for children with disabilities who require a gastrostomy tube. J Pediatr Nurs. 1998; 13: 234-243.
[20]	Khalil ST, Uhing MR, Duesing L, Visotcky A, Tarima S, Nghiem-Rao TH et al. Outcomes of infants with home tube feeding: Comparing nasogastric versus gastrostomy tubes. J parenter Enteral Nutr, 2017; 41 (8): 1380-1385.
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APA Style

Indira Chandrasekar, Erica Ortiz, Jennifer Norgaard, Mario Augusto Rojas. (2021). Home Nasogastric Tube Feeding in Patients with Traditional Indications for Gastrostomy Tube Placement. International Journal of Gastroenterology, 5(2), 91-95. https://doi.org/10.11648/j.ijg.20210502.19

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ACS Style

Indira Chandrasekar; Erica Ortiz; Jennifer Norgaard; Mario Augusto Rojas. Home Nasogastric Tube Feeding in Patients with Traditional Indications for Gastrostomy Tube Placement. Int. J. Gastroenterol. 2021, 5(2), 91-95. doi: 10.11648/j.ijg.20210502.19

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AMA Style

Indira Chandrasekar, Erica Ortiz, Jennifer Norgaard, Mario Augusto Rojas. Home Nasogastric Tube Feeding in Patients with Traditional Indications for Gastrostomy Tube Placement. Int J Gastroenterol. 2021;5(2):91-95. doi: 10.11648/j.ijg.20210502.19

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@article{10.11648/j.ijg.20210502.19,
  author = {Indira Chandrasekar and Erica Ortiz and Jennifer Norgaard and Mario Augusto Rojas},
  title = {Home Nasogastric Tube Feeding in Patients with Traditional Indications for Gastrostomy Tube Placement},
  journal = {International Journal of Gastroenterology},
  volume = {5},
  number = {2},
  pages = {91-95},
  doi = {10.11648/j.ijg.20210502.19},
  url = {https://doi.org/10.11648/j.ijg.20210502.19},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijg.20210502.19},
  abstract = {Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusion: 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.},
 year = {2021}
}

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TY  - JOUR
T1  - Home Nasogastric Tube Feeding in Patients with Traditional Indications for Gastrostomy Tube Placement
AU  - Indira Chandrasekar
AU  - Erica Ortiz
AU  - Jennifer Norgaard
AU  - Mario Augusto Rojas
Y1  - 2021/12/03
PY  - 2021
N1  - https://doi.org/10.11648/j.ijg.20210502.19
DO  - 10.11648/j.ijg.20210502.19
T2  - International Journal of Gastroenterology
JF  - International Journal of Gastroenterology
JO  - International Journal of Gastroenterology
SP  - 91
EP  - 95
PB  - Science Publishing Group
SN  - 2640-169X
UR  - https://doi.org/10.11648/j.ijg.20210502.19
AB  - Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusion: 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.
VL  - 5
IS  - 2
ER  -

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Author Information

Indira Chandrasekar

Division of Neonatology, Valley Children’s Hospital Healthcare, Madera, USA
Erica Ortiz

Division of Neonatology, Valley Children’s Hospital Healthcare, Madera, USA
Jennifer Norgaard

Division of Neonatology, Valley Children’s Hospital Healthcare, Madera, USA
Mario Augusto Rojas

Division of Neonatology, Valley Children’s Hospital Healthcare, Madera, USA

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Plain Text BibTeX RIS

APA Style

Indira Chandrasekar, Erica Ortiz, Jennifer Norgaard, Mario Augusto Rojas. (2021). Home Nasogastric Tube Feeding in Patients with Traditional Indications for Gastrostomy Tube Placement. International Journal of Gastroenterology, 5(2), 91-95. https://doi.org/10.11648/j.ijg.20210502.19

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ACS Style

Indira Chandrasekar; Erica Ortiz; Jennifer Norgaard; Mario Augusto Rojas. Home Nasogastric Tube Feeding in Patients with Traditional Indications for Gastrostomy Tube Placement. Int. J. Gastroenterol. 2021, 5(2), 91-95. doi: 10.11648/j.ijg.20210502.19

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AMA Style

Indira Chandrasekar, Erica Ortiz, Jennifer Norgaard, Mario Augusto Rojas. Home Nasogastric Tube Feeding in Patients with Traditional Indications for Gastrostomy Tube Placement. Int J Gastroenterol. 2021;5(2):91-95. doi: 10.11648/j.ijg.20210502.19

Copy | Download

@article{10.11648/j.ijg.20210502.19,
  author = {Indira Chandrasekar and Erica Ortiz and Jennifer Norgaard and Mario Augusto Rojas},
  title = {Home Nasogastric Tube Feeding in Patients with Traditional Indications for Gastrostomy Tube Placement},
  journal = {International Journal of Gastroenterology},
  volume = {5},
  number = {2},
  pages = {91-95},
  doi = {10.11648/j.ijg.20210502.19},
  url = {https://doi.org/10.11648/j.ijg.20210502.19},
  eprint = {https://article.sciencepublishinggroup.com/pdf/10.11648.j.ijg.20210502.19},
  abstract = {Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusion: 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.},
 year = {2021}
}

Copy | Download

TY  - JOUR
T1  - Home Nasogastric Tube Feeding in Patients with Traditional Indications for Gastrostomy Tube Placement
AU  - Indira Chandrasekar
AU  - Erica Ortiz
AU  - Jennifer Norgaard
AU  - Mario Augusto Rojas
Y1  - 2021/12/03
PY  - 2021
N1  - https://doi.org/10.11648/j.ijg.20210502.19
DO  - 10.11648/j.ijg.20210502.19
T2  - International Journal of Gastroenterology
JF  - International Journal of Gastroenterology
JO  - International Journal of Gastroenterology
SP  - 91
EP  - 95
PB  - Science Publishing Group
SN  - 2640-169X
UR  - https://doi.org/10.11648/j.ijg.20210502.19
AB  - Background: 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. Objective: 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. Methods: 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. Results: 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. Conclusion: 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.
VL  - 5
IS  - 2
ER  -

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