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Am J Perinatol 2024; 41(09): 1171-1177
DOI: 10.1055/s-0042-1748161
Original Article

Clinical Outcomes of Neonatal Intensive Care Unit Graduates with Bridled Nasogastric Feeding Tubes

Elizabeth B. McBride 
1   Division of Neonatology, Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
,
Michael R. Lasarev
2   Department of Biostatistics and Medical Informatics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
,
Daniel M. O'Connell
3   Division of Gastroenterology, Hepatology, and Nutrition, Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
,
Jamie J. Limjoco
1   Division of Neonatology, Department of Pediatrics, University of Wisconsin-Madison School of Medicine and Public Health, Madison, Wisconsin
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Abstract

Objective The aim of this study was to describe clinical outcomes of bridled nasogastric tube (NGT) program implementation for infants requiring assisted home feeding (AHF) to discharge from the neonatal intensive care unit (NICU).

Study Design This was a descriptive prospective analysis of a pilot cohort of infants after implementation of a bridled NGT AHF program to facilitate discharge from level III and IV NICUs from March 2019 to October 2020.

Results Of 29 attempts in infants, 22 infants were discharged with bridled NGTs over 18 months. Bridle placement was unsuccessful in three patients, and four bridles were removed before discharge. Bridle use ranged from 7 to 125 days, with a median duration of 37 days. Dislodgement rate was 0.69 per 100 days. Seventeen infants (77%) achieved full oral feeds, while five (23%) discharged with bridled NGTs later converted to gastrostomy tubes.

Conclusion Implementation of a bridled NGT program is feasible for level III and IV NICUs to facilitate discharging infants who require feeding support to transition home.

Key Points

  • Bridled NGT use after NICU is typically 1 month.

  • Infants have low bridle NGT dislodgement.

  • Most bridled NGT NICU grads attain full oral feeds.

Keywords

bridle - nasogastric feeding tube - gastrostomy tube - infant

Authors' Contributions

E.B.M designed the study, obtained data, and wrote the manuscript. M.R.L. performed statistical analysis. J.J.L. designed the study and participated in manuscript editing. D.M.O. participated in the study design and manuscript editing.




Publication History

Received: 12 October 2021

Accepted: 09 March 2022

Article published online:
17 May 2022

© 2022. Thieme. All rights reserved.

Thieme Medical Publishers, Inc.
333 Seventh Avenue, 18th Floor, New York, NY 10001, USA

 

  • References

  • 1 White BR, Zhang C, Presson AP, Friddle K, DiGeronimo R. Prevalence and outcomes for assisted home feeding in medically complex neonates. J Pediatr Surg 2019; 54 (03) 465-470
    CrossrefPubMedSearch in Google Scholar
  • 2 Hatch LD, Scott TA, Walsh WF, Goldin AB, Blakely ML, Patrick SW. National and regional trends in gastrostomy in very low birth weight infants in the USA: 2000-2012. J Perinatol 2018; 38 (09) 1270-1276
    CrossrefPubMedSearch in Google Scholar
  • 3 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
    CrossrefPubMedSearch in Google Scholar
  • 4 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 (08) 1380-1385
    CrossrefPubMedSearch in Google Scholar
  • 5 Lagatta JM, Uhing M, Acharya K. et al. Actual and potential impact of a home nasogastric tube feeding program for infants whose neonatal intensive care unit discharge is affected by delayed oral feedings. J Pediatr 2021; 234: 38-45.e2
    CrossrefPubMedSearch in Google Scholar
  • 6 Ermarth A, Thomas D, Ling CY, Cardullo A, White BR. Effective tube weaning and predictive clinical characteristics of NICU patients with feeding dysfunction. JPEN J Parenter Enteral Nutr 2020; 44 (05) 920-927
    CrossrefPubMedSearch in Google Scholar
  • 7 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 (Suppl. 01) e207-e214
    Thieme ConnectPubMedSearch in Google Scholar
  • 8 Guerriere DN, McKeever P, Llewellyn-Thomas H, Berall G. Mothers' decisions about gastrostomy tube insertion in children: factors contributing to uncertainty. Dev Med Child Neurol 2003; 45 (07) 470-476
    CrossrefPubMedSearch in Google Scholar
  • 9 Bechtold ML, Nguyen DL, Palmer LB, Kiraly LN, Martindale RG, McClave SA. Nasal bridles for securing nasoenteric tubes: a meta-analysis. Nutr Clin Pract 2014; 29 (05) 667-671
    CrossrefPubMedSearch in Google Scholar
  • 10 McGuirt WF, Strout JJ. “How I do it”–head and neck. A targeted problem and its solution: securing of intermediate duration feeding tubes. Laryngoscope 1980; 90 (12) 2046-2048
    CrossrefPubMedSearch in Google Scholar
  • 11 Power S, Smyth N, Duggan S, Roddy M, Feehan S. The nasal bridle: a useful approach to prevent the dislodgement of feeding tubes. e-SPEN 2010; 5: e73-e76
    CrossrefPubMedSearch in Google Scholar
  • 12 Newton LE, Abdessalam SF, Raynor SC, Lyden ER, Cusick RA. Stabilization of Nasoenteric Feeding Tubes Using Nasal Bridles In Paediatric Patients. Matern Pediatr Nutr 2016; 2: 111
    CrossrefPubMedSearch in Google Scholar
  • 13 Webb G, Gupta P, Fitchett J, Simmons J, De Silva A. Efficacy of nasal bridles in avoiding percutaneous endoscopic gastrostomy placement. Frontline Gastroenterol 2012; 3 (02) 109-111
    CrossrefPubMedSearch in Google Scholar
  • 14 Parzen M, Lipsitz S, Ibrahim J, Klar N. An estimate of the odds ratio that always exists. J Comp Graph Stat 2002; 11 (02) 420-436
    CrossrefPubMedSearch in Google Scholar
  • 15 R Core Team. . R: A Language and Environmental for Statistical Computing. Vienna: R Foundation for Statistical Computing; 2020. Available at: http://cran-r.project.org
    PubMed
  • 16 Kang KEB, Medina M, DiSomma N. et al. Nasal bridling of nasoenteric feeding tubes: implementation program in the pediatric surgical population less than 1 year old. J Pediatr Surg Nurs 2018; 7 (01) 29-33
    CrossrefPubMedSearch in Google Scholar
  • 17 Viswanathan S, Jadcherla S. Transitioning from gavage to full oral feeds in premature infants: when should we discontinue the nasogastric tube?. J Perinatol 2019; 39 (09) 1257-1262
    CrossrefPubMedSearch in Google Scholar
  • 18 Clawson B, Selden M, Lacks M, Deaton AV, Hall B, Bach R. Complex pediatric feeding disorders: using teleconferencing technology to improve access to a treatment program. Pediatr Nurs 2008; 34 (03) 213-216
    PubMedSearch in Google Scholar
  • 19 Feehan K, Kehinde F, Sachs K. et al. Development of a multidisciplinary medical home program for NICU graduates. Matern Child Health J 2020; 24 (01) 11-21
    CrossrefPubMedSearch in Google Scholar
  • 20 Pahsini K, Marinschek S, Khan Z, Dunitz-Scheer M, Scheer PJ. Unintended adverse effects of enteral nutrition support: parental perspective. J Pediatr Gastroenterol Nutr 2016; 62 (01) 169-173
    CrossrefPubMedSearch in Google Scholar
  • 21 Pedersen SD, Parsons HG, Dewey D. Stress levels experienced by the parents of enterally fed children. Child Care Health Dev 2004; 30 (05) 507-513
    CrossrefPubMedSearch in Google Scholar
  • 22 Northington L, Lyman B, Guenter P, Irving SY, Duesing L. Current practices in home management of nasogastric tube placement in pediatric patients: a survey of parents and homecare providers. J Pediatr Nurs 2017; 33: 46-53
    CrossrefPubMedSearch in Google Scholar