Optimal Feeding Tube Dwell Time in VLBW to Reduce Feeding Tube Contamination

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Because premature VLBW infants are too immature to orally feed, they require a feeding tube for weeks to months to meet their nutritional needs. These feeding tubes are a reservoir for pathogenic and antibiotic resistant bacteria and may increase the risk of necrotizing enterocolitis, late onset sepsis and feeding intolerance and are thus a risk to neonatal health. In the neonatal intensive care unit (NICU), guidelines regarding feeding tube dwell time are non-existent and feeding tubes are often not replaced for weeks following insertion. As with other external devices, such as central venous lines and urinary catheters, the risk of bacterial contamination increases the longer the device remains in place. Contaminated feeding tubes in premature VLBW infants can cause gastrointestinal (GI) microbial dysbiosis and inflammation, thereby increasing the risk of complications including necrotizing enterocolitis, late onset sepsis and feeding intolerance. The optimal feeding tube dwell time to decrease feeding tube contamination and the extent to which contamination causes GI microbial dysbiosis and inflammation and subsequent risk to neonatal health is unknown. The overall objective of this 4-year study is to determine if a maximum feeding tube dwell time of 48 hours reduces contamination compared to a maximum feeding tube dwell time of 7 days (current practice), thereby improving neonatal health outcomes. The proposed study will follow a prospective cohort (N = 120) of racially and economically diverse premature VLBW infants for 4 weeks following birth. Infants will be randomized into 1 of 2 groups. Feeding tubes will be changed every 0-48 hours (Group 1) and every 7 days (standard practice) (Group 2). Aim 1. will determine the effect of feeding tube dwell time on feeding tube hub, feeding tube, and intraluminal fluid contamination, bacterial pathogenicity, and biofilm formation in premature VLBW infants. For Aim 2, the effect of feeding tube dwell time on GI microbial dysbiosis and inflammation between Group 1 and Group 2 will be compared. In Aim 3, the effect of feeding tube dwell time, feeding tube contamination and biofilm formation on selected health outcomes will be determined. Results are expected to fill an important gap in research regarding feeding tube dwell time in premature VLBW infants, whether dwell time increases the risk of GI microbial dysbiosis and inflammation and whether feeding tube dwell time influences health outcomes.