Nasogastric Tube Discharge Home

Pathway Background and Objectives

Factors that may contribute to extended hospital stays for premature infants include inability to feed fully by mouth and differences in approaches for discharge home with partial nasogastric (NG) feeds across hospital subspecialties. Once discharged, these families may experience inconsistent regional support for infants requiring home NG feedings including difficulties with NG tube replacements, limited supplies, and challenges obtaining follow up with subspecialists. Around the country, NICUs and pediatric sub-specialists have been able to develop effective systems for management of neonatal home NG feeding post-discharge. This is an opportunity to standardize and improve care by discharging select neonatal patients with NG tubes for home use. We will provide criteria for NG feeds after hospital discharge as well as review required discharge education for caregivers caring for an NG tube at home.

Algorithm   Educational Module

 

Resources

  • Days in NICU waiting solely on progression of oral feeds
  • G tube placement prior to 48 weeks post menstrual age (PMA)
  • Parent satisfaction with home NG tube or G tube
  • Days to liberation from NG tube feeds
  • Total length of stay in NICU
  • Percentage of home NG tube fed patients needing an eventual G tube
  • Percentage of home tube-fed patients with adequate weight gain (20-30 grams/day)
  • Alshaikh B, Yusuf K, Dressler-Mund D, et al. Rates and Determinants of Home Nasogastric Tube Feeding in Infants Born Very Preterm. J Pediatr. 2022;246:26-33.e2.
  • Ermarth A, Ling CY. Partial Enteral Discharge Programs for High-risk Infants. Neoreviews. 2022;23(1):e13-e22.
  • Khalil ST, Uhing MR, Duesing L, Visotcky A, Tarima S, Nghiem-Rao TH. Outcomes of Infants With Home Tube Feeding: Comparing Nasogastric vs Gastrostomy Tubes. JPEN J Parenter Enteral Nutr. 2017;41(8):1380-1385.
  • Mago-Shah DD, Malcolm WF, Greenberg RG, Goldstein RF. Discharging Medically Complex Infants with Supplemental Nasogastric Tube Feeds: Impact on Neonatal Intensive Care Unit Length of Stay and Prevention of Gastrostomy Tubes. Am J Perinatol. 2021;38(S 01):e207-e214.
  • Vergales BD, Murray PD, Miller SE, Vergales JE. Safety and efficacy of a home nasogastric monitoring program for premature infants. J Neonatal Perinatal Med. 2022;15(1):165-170.
  • Williams SL, Popowics NM, Tadesse DG, Poindexter BB, Merhar SL. Tube feeding outcomes of infants in a Level IV NICU. J Perinatol. 2019;39(10):1406-1410.

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