Objective: To compare healthcare utilization and parent health-related quality of life (HRQL) in three groups of infants whose neonatal intensive care unit (NICU) discharge was delayed by oral feedings.
Study design: prospective single-center cohort of infants in the NICU from September 2018-March 2020. After enrollment, weekly chart review determined eligibility for home nasogastric (NG) feeds based on predetermined criteria. Actual discharge feeding decisions were at clinical discretion. At 3 months post-discharge, we compared acute healthcare utilization and parental health-related quality of life (HRQL), measured by the PedsQL Family Impact Module, among infants who were NG eligible but discharged with all oral feeds, discharged with NG feeds, and discharged with G tubes. We calculated NICU days saved by home NG discharges.
Results: Among 180 infants, 80 were orally fed, 35 used NG and 65 used G tubes. Compared with NG-fed infants, G-tube-fed infants had more GI or tube-related readmissions and emergency encounters (unadjusted OR 3.97, 95%CI 1.3-12.7, p=0.02), and orally-fed infants showed no difference in utilization (unadjusted OR 0.41, 95%CI 0.1-1.7, p=0.225). Multivariable adjustment did not change these comparisons. Parent HRQL at 3 months did not differ between groups. Infants discharged home with NG tubes saved 1574 NICU days.
Conclusions: NICU discharge with NG feeds is associated with reduced NICU stay without increased post-discharge healthcare utilization or decreased parent HRQL, whereas G tube feeding was associated with increased post-discharge healthcare utilization.