Skip Navigation LinksHome > January 2012 - Volume 54 - Issue 1 > Impact of Personalized Feeding Program in 100 NICU Infants:...
Journal of Pediatric Gastroenterology & Nutrition:
doi: 10.1097/MPG.0b013e3182288766
Original Articles: Hepatology and Nutrition

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**

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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.

Copyright 2012 by ESPGHAN and NASPGHAN

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