Partial Enteral Discharge Programs for High-risk Infants

NeoReviews ◽  
2022 ◽  
Vol 23 (1) ◽  
pp. e13-e22
Author(s):  
Anna Ermarth ◽  
Con Yee Ling
Keyword(s):  
High Risk ◽  
Enteral Nutrition ◽  
Premature Infants ◽  
Nasogastric Tube ◽  
Outpatient Setting ◽  
Oral Feeding ◽  
Gastrostomy Tube ◽  
Medical Problems ◽  
Increased Risk ◽  
High Risk Infants

Premature infants or infants born with complex medical problems are at increased risk of having delayed or dysfunctional oral feeding ability. These patients typically require assisted enteral nutrition in the form of a nasogastric tube (NGT) during their NICU hospitalization. Historically, once these infants overcame their initial reason(s) for admission, they were discharged from the NICU only after achieving full oral feedings or placement of a gastrostomy tube. Recent programs show that these infants can be successfully discharged from the hospital with partial NGT or gastrostomy tube feedings with the assistance of targeted predischarge education and outpatient support. Caregiver opinions have also been reported as satisfactory or higher with this approach. In this review, we discuss the current literature and outcomes in infants who are discharged with an NGT and provide evidence for safe practices, both during the NICU hospitalization, as well as in the outpatient setting.

School Achievement, Behavioural Adjustment and Health at Nine Years of Age in a Population of lnfants who were Born Preterm or Required Prolonged Mechanical Ventilation

1989 ◽  
Vol 6 (1) ◽  
pp. 15-18 ◽  
Author(s):  
Heather Mohay ◽  
Michael O’Callaghan ◽  
Yvonne Burns ◽  
David Tudehope
Keyword(s):  
Prolonged Mechanical Ventilation ◽  
School Achievement ◽  
Medical Knowledge ◽  
Good Health ◽  
Severe Disabilities ◽  
Behaviour Problems ◽  
Medical Problems ◽  
Increased Risk ◽  
Behavioural Adjustment ◽  
High Risk Infants

ABSTRACTWith advances in medical knowledge, increasing numbers of very small and very sick infants are surviving. Only a small percentage of these infants have severe disabilities. However, the risk of more subtle handicapping conditions such as learning disabilities, behaviour problems and recurrent illness needs to be assessed. The prevalence of these conditions in a population of 88 high risk infants was investigated when these children reached nine years of age. In general, the children were found to be in good health, although there was an increased risk of asthma. In contrast, a high percentage were experiencing learning difficulties or exhibiting behaviour problems. Thus, the medical problems of infancy appeared to have been replaced with educationaland behavioural problems in the school years. The perinatal, developmental and social antecedents of these problems require further investigation.

Perioperative Management of High Risk Patients with Cardiopulmonary Disease Undergoing Carotid Endarterectomy or Extracranial-Intracranial Bypass

Neurosurgery ◽  
1982 ◽  
Vol 10 (4) ◽  
pp. 422-427 ◽  
Author(s):  
Michael B. Pritz ◽  
Glenn W. Kindt
Keyword(s):  
High Risk ◽  
Carotid Endarterectomy ◽  
Perioperative Management ◽  
Myocardial Function ◽  
Perioperative Period ◽  
Medical Problems ◽  
High Risk Patients ◽  
Increased Risk ◽  
Risk Patients ◽  
Cardiopulmonary Monitoring

Abstract Among a large group of patients who underwent either carotid endarterectomy or extracranial-intracranial (EC-IC) bypass were 13 patients who had cardiopulmonary monitoring performed by a dye dilution technique either with or without a thermodilution Swan-Ganz catheter. Each patient had at least two significant medical problems that were thought to place him or her at increased risk. The usefulness of this monitoring approach in the perioperative management of these patients is demonstrated by several clinical examples. No patient sustained myocardial infarction, congestive heart failure, or new neurological deficit during the perioperative period. Our experience suggests that high risk patients can safely undergo either carotid endarterectomy or EC-IC bypass provided that careful attention is paid to myocardial function and the state of hydration.

Increased risk of eczema but reduced risk of early wheezy disorder from exclusive breast-feeding in high-risk infants

2010 ◽  
Vol 125 (4) ◽  
pp. 866-871 ◽  
Author(s):  
Charlotte Giwercman ◽  
Liselotte B. Halkjaer ◽  
Signe Marie Jensen ◽  
Klaus Bønnelykke ◽  
Lotte Lauritzen ◽  
...  
Keyword(s):  
High Risk ◽  
Breast Feeding ◽  
Exclusive Breast Feeding ◽  
Increased Risk ◽  
High Risk Infants ◽  
Reduced Risk

Strategies to Support Oral Feeding of High-Risk Infants

2019 ◽  
Vol 19 (1) ◽  
pp. 1-2 ◽  
Author(s):  
Jacqueline M. McGrath ◽  
Debra Brandon
Keyword(s):  
High Risk ◽  
Oral Feeding ◽  
High Risk Infants

scholarly journals Severity of respiratory disease is correlated with time of first oral feeding and need for a gastrostomy tube at discharge in premature infants born at <30 weeks of gestation

2021 ◽  
Author(s):  
Emily Anderson ◽  
Matthew Gregoski ◽  
Daniel Gehle ◽  
William Head ◽  
Thomas Hardy ◽  
...  
Keyword(s):  
Premature Infants ◽  
Neonatal Intensive Care ◽  
Retrospective Chart Review ◽  
Oral Feeding ◽  
Gastrostomy Tube ◽  
Respiratory Support ◽  
Respiratory Parameters ◽  
Postmenstrual Age ◽  
Highly Correlated ◽  
Different Levels

Background: Premature infants who cannot achieve full oral feeds may need a gastrostomy tube (GT) to be discharged from the neonatal intensive care unit (NICU). We previously developed a model to predict which infants born <30 weeks (w) gestational age (GA) will require a GT before discharge. Here we report the detailed respiratory variable data to describe the general respiratory course for infants in the NICU <30w GA at birth and the association between different levels of respiratory support with postmenstrual age (PMA) at the time of first oral feeding attempt (PMAff), including later need for GT for discharge. Methods: Retrospective chart review of 391 NICU admissions comprising test (2015-2016) and validation (2017-2018) cohorts. Data, including respiratory support, were collected on 204 infants, 41 GT and 163 non-GT, in the test cohort, and 187 infants, 37 GT and 150 non-GT, in the validation cohort. Results: Respiratory data were significantly different between GT and non-GT infants. Infants who required GT for discharge were on significantly higher respiratory support at 30 days of age, 32w PMA, and 36w PMA. Respiratory parameters were highly correlated with PMAff. Conclusion: Respiratory status predicts PMAff, which was the variable in our previously described model that was most predictive of failure to achieve full oral feeing. These data provide a catalyst to develop strategies for improving oral feeding outcome for infants requiring prolonged respiratory support in the NICU.

Neonatal Neurodevelopmental Examination as a Predictor of Neuromotor Outcome in Premature Infants

PEDIATRICS ◽  
1989 ◽  
Vol 83 (4) ◽  
pp. 498-506
Author(s):  
Marilee C. Allen ◽  
Arnold J. Capute
Keyword(s):  
High Risk ◽  
Premature Infants ◽  
Social Variables ◽  
Visual Responses ◽  
Oxygen Supplementation ◽  
Infancy And Childhood ◽  
Cranial Nerve Function ◽  
High Risk Infants ◽  
And Behavior ◽  
Neonatal Examination

There was a marked correlation (P &lt; .000001) between neonatal neurodevelopmental examination results and neuromotor outcome at 1 year of age or older in 210 high-risk premature infants (mean birth weight 1,107 g, mean gestational age 28.4 weeks). This neonatal examination consisted of assessment of posture, extremity and axial tone, deep tendon reflexes, pathologic reflexes, primitive reflexes, symmetry, oromotor function, cranial nerve function, auditory and visual responses, and behavior. Premature infants whose neonatal neurodevelopmental examination results were abnormal had significantly higher incidences of both cerebral palsy (38% v 6%, P &lt; .000001) and minor neuromotor dysfunction (27% v 13%, p &lt; .05) than did premature infants whose examination results were normal. This correlation continued to be highly significant even with the analysis of subgroups (infants born at or before 27 weeks' gestation, infants with chronic lung disease discharged with oxygen supplementation, infants with periventricular hemorrhage) and when a variety of individual perinatal, demographic, and social variables were used as controls. Normal or nearly normal neonatal neurodevelopmental examination results can be used to reassure parents of high-risk premature infants. Although abnormal neonatal neurodevelopmental examination results cannot be used to diagnose handicap in premature infants, they can be used to select a group of high-risk infants who should be carefully monitored during infancy and childhood.

Perinatal Brain Injury in the Premature Infant

2003 ◽  
Vol 22 (1) ◽  
pp. 61-69
Author(s):  
Martha Wilson Jones ◽  
W. Thomas Bass
Keyword(s):  
Brain Injury ◽  
High Risk ◽  
Premature Infant ◽  
Premature Infants ◽  
Absolute Number ◽  
Perinatal Brain Injury ◽  
Neurologic Deficits ◽  
Neurologic Disability ◽  
The Absolute ◽  
High Risk Infants

APPROXIMATELY 85 PERCENT OF infants with birth weights ≤1,500 gm now survive.1 Infants with birth weights <1,000 gm—the group contributing most to this increase in survival—have the greatest incidence of brain injury. Overall, the rates of neurologic disability have remained the same; therefore, the survival of more high-risk infants has increased the absolute number of NICU graduates with neurologic deficits.2–4 This concerns all involved in the care and lives of premature infants.

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