Impact of Personalized Feeding Program in 100 NICU Infants: Pathophysiology-based Approach for Better Outcomes

Jadcherla, Sudarshan R.*; Peng, Juan; Moore, Rebecca; Saavedra, Jason§; Shepherd, Edward||; Fernandez, Soledad; Erdman, Steven H.#; DiLorenzo, Carlo**

Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e3182288766
Original Articles: Hepatology and Nutrition
Abstract

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.

Author Information

*Neonatal and Infant Feeding Disorders Program, Center for Perinatal Research, Innovative Infant Feeding Disorders Research Program, the Research Institute at Nationwide Children's Hospital, Sections of Neonatology, Pediatric Gastroenterology, Hepatology and Nutrition, Ohio State University College of Medicine

Neonatal and Infant Feeding Disorders Program, Center for Perinatal Research, the Research Institute at Nationwide Children's Hospital

Neonatal and Infant Feeding Disorders Program, Center for Perinatal Research, the Research Institute at Nationwide Children's Hospital

§Division of Neonatal Nurse Practitioners Program, Nationwide Children's Hospital

||Section of Neonatology, Department of Pediatrics, Ohio State University College of Medicine

Department of Biostatistics, Ohio State University College of Medicine and Public Health

#Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Ohio State University College of Medicine

**Division of Pediatric Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Ohio State University College of Medicine, Columbus, OH.

Address correspondence and reprint requests to Sudarshan R. Jadcherla, MD, Section of Neonatology, 700 Children's Dr, Nationwide Children's Hospital, Columbus, OH 43205 (e-mail: sudarshan.jadcherla@nationwidechildrens.org).

Received 4 April, 2011

Accepted 8 June, 2011

This study was supported in part by Nationwide Children's Hospital and NIH grant R01 DK 068158 (Jadcherla).

The authors report no conflicts of interest.

Copyright 2012 by ESPGHAN and NASPGHAN