332 - Meet and Eat: The Safety and Efficacy of Discharging NICU Infants Home with Nasogastric Tube Feeds

Publication Number: 3320.332

Katrina Hillam, Connecticut Children's Medical Center, Hartford, CT, United States; Usha Prasad, Connecticut Children's Medical Center, Hartford, CT, United States; Alaina Pyle, Connecticut Children's Medical Center, Hartford, CT, United States; Allyson McDermott, Connecticut Children's Medical Center, West Hartford, CT, United States; Bella Zeisler, Connecticut Children's Medical Center, west hartford, CT, United States; Heidi P. Sweeney, CCMC, West Hartford, CT, United States

Background: Full oral feeding is typically required to discharge an infant from the NICU, and can delay discharge home by days to weeks. The challenge of identifying if/when this skill will develop can sometimes lead medical teams to recommend gastrostomy tube (GT) placement when it was not needed long-term. Many institutions have started home nasogastric tube (NGT) feed programs with promising initial results but there remains a need for additional data on safety and efficacy.

Objective: Our study seeks to add to the cumulative data on safety of home NGT feeding and establish a baseline as our program evolves.

Design/Methods: A multidisciplinary, multispecialty team was created to develop guidelines to discharge neonates home with an NGT, generate parent education, and streamline outpatient management. Outpatient Gastroenterology (GI) provided weight checks, feeding adjustments, and coordinated care. Home care nurses are occasionally available to troubleshoot NGTs, but primarily parents manage their child's feeds, check NGT placement, and navigate challenges with GI support.

Discharging infants qualified for home NGT feeds if they were ≥40 weeks post-menstrual age (PMA), >2kg, anticipated ≤6 months to full PO, able to take >100mL/kg/d PO, and had two caregivers trained to manage NGT feeds. Infants were excluded from the home NGT program if they required continuous feeds, home oxygen, or had airway compromise.

Demographic and clinical data were obtained by retrospective chart review of all infants discharged with NGT or GT feeds Jan 2022-May 2025 (Tables 1-3).

Results: Over the study time period, 82 infants discharged home with GT and 42 discharged home with NGT. Preliminary data analysis showed no significant difference in weight gain between the two groups (Table 3). 8 babies discharged with an NGT ultimately required a GT placement and only 3 patients discharged with GT had it removed within 12 months. No patients had severe complications and no aspiration events were noted. See Tables 2 and 3 for further details.

Conclusion(s): Our home NGT program resulted in significantly more ED visits after discharge, almost all for NGT replacements. Importantly, 81% of babies discharged with NGT feeds did not require a GT. Our data supports the prevailing postulate that home NGT programs are safe and effective, and can help reduce the need for GT procedures in the NICU population. Next steps include increasing partnership with parents by teaching them to replace NGTs at home to reduce unnecessary medical visits. Data collection is ongoing as we continue to evaluate the safety and efficacy of this program.

Table 1
Demographic makeup of the cohort of infants in total, and by those requiring NGT vs GT feeds on discharge. Mann-Whitney significance test was performed for continuous variables and Chi-square was run for categorical variables.

Table 2
Association of modality of feeds and characteristics of inpatient stay. Sepsis was defined as culture-positive episode not thought to be contaminant, NEC was defined as stages 2-4, IVH as grades 2-4, and BPD was defined as requiring O2 at 36 weeks PMA. Significance determined by Mann-Whitney test.

Table 3
Impact of NGT and GT feeds on outpatient outcomes. Significance determined by Mann-Whitney test.