Nasogastric Tube Discharge Home Clinical Pathway

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

Appendix A: Caregiver Education Guide for NG Feeds (English)
Appendix A: Caregiver Education Guide for NG Feeds (Spanish)
Appendix B: NG Caregiver Education Handout (English)
Appendix B: NG Caregiver Education Handout (Spanish)
Appendix C: NG Integrated Care Plan (English)
Appendix C: NG Integrated Care Plan (Spanish)

Quality Metrics

Percentage of patients with pathway order set
Percentage of patients with G-tube placed prior to discharge
Percentage of patients with G-tube placed within 3 months and within 6 months of discharge
Percentage of patients discharged home on NG tube feeds
Percentage of patients with GI consult prior to discharge
Percentage of patients with GI follow-up clinic appointment within 2 weeks of discharge
Percentage of patients with VNA established prior to discharge
Percentage of patients with failure to thrive diagnosis by 3 months post discharge and by 6 months post discharge
ED visits within 3 months and within 6 months of discharge (all cause)
Readmissions within 3 months and within 6 months of discharge (all cause)
Admit length of stay
Number of patients discharged home on G-tube and NG tube stratified by unit

Key References

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.

Disclaimer

The clinical pathways in the above links have been developed specifically for use at Connecticut Children’s and are made available publicly for informational and/or educational purposes only. The clinical pathways are not intended to be, nor are they, a substitute for individualized professional medical judgment, advice, diagnosis, or treatment. Although Connecticut Children’s makes all efforts to ensure the accuracy of the posted content, Connecticut Children’s makes no warranty of any kind as to the accuracy or completeness of the information or its fitness for use at any particular facility or in any individual case.