Neonatal and infant feeding disorders program saves infants from lifetime of feeding tubes

An innovative approach to treating neonatal feeding problems at Nationwide Children's Hospital has allowed infants who were struggling to feed orally to be discharged earlier and without feeding tubes, subsequently saving millions of annual healthcare charges.

According to American Academy of Pediatrics guidelines, in order for to be discharged from the hospital, they must establish safe oral feeding methods. The prevalence of feeding problems in once-premature infants is twice that of full-term infants and often prolongs hospitalization for these babies. Infants who fail to gain skills necessary to feed orally often receive gastrostomy tubes, tubes placed within a baby's stomach through which he/she can receive nutrition. For the first year, home gastrostomy feeding methods cost nearly $47,000.

The study, appearing in the Journal of Pediatric Gastroenterology and Nutrition, details outcomes for 100 unit (NICU) infants referred to the Neonatal and Infant Feeding Disorders Program at Nationwide Children's for a feeding strategy in an effort to avoid gastrostomy placement. Their feeding capabilities were detailed at birth, at the time of feeding evaluation, at discharge and at 1 year of age.

Because they received an individualized feeding strategy, 51 percent of these infants were feeding successfully upon discharge and 84 percent at 1 year of age. Even among the gastrostomy infants, the vast majority of patients went on to recover significant oral motor skills.

The integrated feeding strategy led to a higher feeding success than traditional methods. Of 50 infants who received conventional treatment in years prior to the Neonatal and Infant Feeding Disorders Program, 10 percent were feeding orally at discharge and 42 percent at 1 year of age.

"Being able to successfully develop feeding strategies for these infants provides them a greatly improved , improves parental satisfaction and leads to a reduced ," said Sudarshan Jadcherla, MD, FRCPI, DCH, AGAF, Nationwide Children's Hospital neonatologist and principal investigator in the Center for Perinatal Research, medical director of the Neonatal and Disorders Program at Nationwide Children's and lead author of the study. Among the 100 infants in this study, there was an estimated $3.8 million cost savings over one year – $2.1 million in savings from avoided gastrostomy tube placement, $1.7 million in savings because of earlier discharge from the .

Dr. Jadcherla, also professor of Pediatrics at The Ohio State University College of Medicine and Public Health, says the strength of the feeding strategy described in this study lies in the fact that it is multidisciplinary, individualized and evidence-based. First, clinicians documented each infant's feeding difficulty symptoms and noted any underlying disease. Each infant underwent specialized pharyngo-esophageal manometry and swallow studies to evaluate the structure and function of his/her aerodigestive system. Further studies and input from a multidisciplinary team helped characterize the mechanisms of each infant's feeding difficulty and their symptoms. These findings were discussed with parents. An individualized feeding management strategy was developed for each infant with special emphasis on feeding mechanics, feeding methods, co-morbidities, nutrition and growth. Finally, nurses, feeding therapists and parents were educated on the baby's feeding plan.

"This is the first study to describe an innovative approach to diagnose feeding problems and implement management strategies to improve oral feeding outcomes at discharge and followed at 1-year, among complex NICU expected to receive gastrostomy tubes," said Dr. Jadcherla.

add to favorites email to friend print save as pdf

Related Stories

Fed When Hungry, Premature Babies Go Home Sooner

Feb 17, 2010

Although many parents and health care providers attempt to schedule a preterm newborn’s feeding pattern, a new review of studies reveals that feeding in response to the infant’s own hunger cues might result in earlier ...

Even the sickest babies benefit from breast-feeding

Oct 27, 2010

Pediatric researchers at The Children's Hospital of Philadelphia describe a successful program in which nurses helped mothers attain high rates of breast-feeding in very sick babies--newborns with complex birth defects requiring ...

Recommended for you

Low Vitamin D may not be a culprit in menopause symptoms

4 hours ago

A new study from the Women's Health Initiative (WHI) shows no significant connection between vitamin D levels and menopause symptoms. The study was published online today in Menopause, the journal of The North American Menopa ...

Internists favor public policy to reduce gun violence

10 hours ago

(HealthDay)—Most internists believe that firearm-related violence is a public health issue and favor policy initiatives aimed at reducing it, according to research published online April 10 in the Annals of ...

iPLEDGE isotretinoin counseling may need updating

10 hours ago

(HealthDay)—The iPLEDGE program needs to provide women with information about more contraceptive choices, including reversible contraceptives, according to research published in the April issue of JAMA De ...

User comments