216 - Feeding Outcomes of Preterm Infants Discharged with Tube Feeds

Preterm infants are at risk for impaired oral feeding. These infants may require feeding tubes (FT), either nasogastric tubes (NGT) or surgically placed gastrostomy tubes (GT), to facilitate discharge from the neonatal intensive care unit (NICU). Little is known about their feeding outcomes.

Objective:

To determine the factors associated with continued need for a FT at 12-months corrected age (CA) among infants discharged with an NGT or GT. Secondary objectives were to assess growth outcomes and FT complications.

Design/Methods:

This was a single-center retrospective study of infants ≤30 weeks gestational age (GA) discharged from a Level IV NICU with a FT between 2012-2020. Exclusions: infants deceased before 12-months CA, lost to follow-up, or those with a diagnosis that could affect oral feeding. Characteristics and outcomes were compared between infants with an NGT and GT, and infants who achieved full oral feeding (FOF) and those who did not. Factors associated with need for FT at 12-months CA were assessed with multivariable regression.

Results:

217 infants were included: 130 discharged with an NGT and 87 with a GT (Table 1). By 12-months CA, 55% of infants achieved FOF. The median time to FOF was 2.18 months after discharge in the NGT group and 6.63 months in the GT group (p< 0.001) (Figure 1). After adjustment, Grade 2-3 bronchopulmonary dysplasia (BPD), pulmonary hypertension (PH), and continuous feeds were associated with increased odds of need for FT at 12-months CA, while greater birthweight z-scores and surgical necrotizing enterocolitis (NEC) or intestinal perforation were associated with decreased odds of need for FT (Table 2). Stratifying by comorbidity, 51% of infants with Grade 2-3 BPD achieved FOF compared to 73% with no or Grade 1 BPD (p=0.004), with no statistical difference in CA at FOF, median CA 4.6 months and 3.2 months, respectively (p=0.062). Dividing the Grade 2-3 BPD cohort by comorbid PH, 37% of infants with BPD-PH achieved FOF compared to 55% of BPD infants without PH (p=0.017). Those with BPD-PH who achieved FOF did so later, at a median CA of 7 months compared to 4 months in infants with BPD alone (p=0.045). Infants who achieved FOF had higher length z-scores at 12-months CA than those with a FT, median of -0.83 compared to -2.00 (p< 0.001), respectively. Infants with a GT experienced more FT complications, 63% compared to 18% in the NGT group (p< 0.000).

Conclusion(s):

In this population, BPD, PH, and continuous feeds were associated with continued need for FT. These findings can help guide FT selection at discharge and identify infants at risk for oral feeding failure.