Effective Tube Weaning and Predictive Clinical Characteristics of NICU Patients With Feeding Dysfunction
Effective Tube Weaning and Predictive Clinical Characteristics of NICU Patients With Feeding Dysfunction
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DOI：
10.1002/jpen.1717
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发表时间：
2019-10-11
影响因子：
3.4
通讯作者：
White, Ben R.
中科院分区：
文献类型：
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作者：
Ermarth, Anna;Thomas, Debbie;White, Ben R.
背景本研究评价了多学科早期出院模式对接受家庭肠内营养（HEN）的新生儿的有效性。方法回顾性分析2016年9月至2018年3月183例新生儿重症监护病房（NICU）出院后接受部分经口喂养（PO）和部分HEN的患者的临床资料。这些患者在由儿科胃肠病学家，新生儿喂养治疗师和儿科营养师领导的多学科诊所进行随访。出院时记录患者的人口统计学和数据，然后对图表进行审查以获得额外数据。结果182例患者中，121例（67%）停用HEN，至完全PO的中位时间为79天（四分位距[IQR] 15，247），出院时中位PO摄入量为20%（0，43）。当比较获得100% PO的患者与未停用HEN的患者时，停用组包括88%的鼻胃管，中位停喂时间为27天（IQR 8，79），出院时中位PO摄入量为29%（11，50）。队列中只有13%的人进入急诊室或住院，这分别对应于每500管日1.6和0.8起事件，特别是由于HEN并发症。结论NICU喂养功能障碍患者在接受HEN治疗的同时，可以安全有效地提前出院回家。我们的数据表明，一个专门的门诊诊所可以促进大多数新生儿的复杂的医学疾病的不良事件发生率低，有效的管断奶。
Background The present study evaluated the effectiveness of a multidisciplinary earlier discharge model for neonates receiving home enteral nutrition (HEN). Methods A retrospective data review and analysis was performed on 183 patients discharged out of the neonatal intensive care unit (NICU) receiving partial oral feeds (PO) and partial HEN from September 2016 to March 2018. These patients were followed in a multidisciplinary clinic led by a pediatric gastroenterologist, a neonatal feeding therapist, and a pediatric dietitian. Demographics and data were recorded for patients at discharge, and then chart reviews were performed for additional data. Results Of 182 patients, 121 (67%) weaned off HEN with a median time to full PO at 79 days (interquartile range [IQR] 15, 247) and had median PO intake of 20% (0, 43) at time of discharge. When comparing patients who gained 100% PO vs patients who did not wean off HEN, the weaned group consisted of 88% nasogastric tubes, with median time off feeds at 27 days (IQR 8, 79) and median PO intake of 29% (11, 50) at discharge. Only 13% of the cohort had an emergency room or hospital admission, which corresponds to 1.6 and 0.8 events, respectively, per 500 tube days specifically due to HEN complications. Conclusions Our study supports that NICU patients with feeding dysfunction can effectively and safely discharge home earlier while receiving HEN. Our data suggest that a dedicated outpatient clinic can facilitate effective tube weaning in a majority of neonates with complex medical diseases with low rates of adverse events.