Open AccessImpact of Personalized Feeding Program in 100 NICU Infants
Author(s) -
Jadcherla Sudarshan R.,
Peng Juan,
Moore Rebecca,
Saavedra Jason,
Shepherd Edward,
Fernandez Soledad,
Erdman Steven H.,
DiLorenzo Carlo
Publication year - 2012
Publication title -
journal of pediatric gastroenterology and nutrition
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.206
H-Index - 131
eISSN - 1536-4801
pISSN - 0277-2116
DOI - 10.1097/mpg.0b013e3182288766
Subject(s) - medicine , feeding tube , neonatal intensive care unit , intestinal failure , pediatrics , early feeding , nasal discharge , prospective cohort study , parenteral nutrition , surgery
Objectives: In neonatal intensive care unit infants referred for home‐tube feeding methods, we evaluated the effect of an innovative diagnostic and management approach on feeding outcomes at discharge and 1 year, by comparing data from historical controls; we hypothesized that clinical and aerodigestive motility characteristics at evaluation were predictive of feeding outcomes at discharge; we assessed the economic impact of feeding outcomes. Patients and Methods: Patients (N = 100) who were referred for development of long‐term feeding management strategy at 46.4 ± 13.1 weeks' postmenstrual age were compared with 50 historical controls that received routine care. The focused approach included swallow‐integrated pharyngoesophageal manometry, individualized feeding strategy, and prospective follow‐up. Feeding success was defined as ability to achieve oral feedings at discharge and 1 year. Motility characteristics were evaluated in relation to feeding success or failure at discharge. Results: Higher feeding success was achieved in the innovative feeding program (vs historical controls) at discharge (51% vs 10%, P < 0.0001) and at 1 year (84.3% vs 42.9%, P < 0.0001), at a reduced economic burden ( P < 0.05). Contributing factors to the innovative program's feeding success (vs feeding failure) were earlier evaluation and discharge (both P < 0.05), greater peristaltic reflex‐frequency to provocation ( P < 0.05), normal pharyngeal manometry ( P < 0.05), oral feeding challenge success ( P < 0.05), and suck‐swallow‐breath‐esophageal swallow sequence ( P < 0.05). Probability of feeding success demonstrated a prediction rate of 79.6%. Conclusions: Short‐term and long‐term feeding outcomes in complex neonates can be significantly improved with innovative feeding strategies at a reduced cost. Clinical and aerodigestive motility characteristics were predictive of outcomes.