Discharge home on short-term nasogastric tube feeding for neonates

Purpose

To safely discharge babies home from NICU or Whitinga Ora Pēpi with nasogastric tube (NGT) feeding and to provide a guide on a personalised weaning process. The aim is to have the short-term NGT out within 14 days. It is a mutual decision between the whānau and multidisciplinary team.

Inclusion criteria

• ≥ 34+0 weeks and ≥ 1800 g

• Off all monitoring for at least 48 hours

• No upper airway anatomical or functional swallowing abnormalities

• Infant is able to take > 50 % oral feeds and has had stable weight gain

Parental exclusion criteria

• Parents who are unable to engage with training

• No 24 hr access to a phone or transport

• No access to Newborn Homecare nurse follow up – i.e. Waiheke Island

Preparing for discharge with NGT feeds

• Referral made to Newborn Homecare via RCP at least 3 days in advance by medical or nursing staff

• Whānau have completed 1-1 CPR session with Starship NICU nurse

• CR4676 training form completed (see clinical forms for Nasogastric Tube Discharge Planning Paediatric CR4676 form)

• Nurses to provide and review the Homecare Short-Term NGT booklet with whānau

• Provide whānau with the opportunity of learning how to insert the NGT. This is not a requirement as infants who are discharged should be able to take 50% oral feeds to maintain hydration until a Homecare Nurse can see them during working hours.

• Whānau discharge meeting held

• Lead SMO updated on plan to discharge baby home on NGT feeds

• The family will be provided with:

  • Newborn Homecare Scale Pack – scales, greenies, Clinell wipes.

  • Nasogastric Supplies – spare short-term NGT, pH paper, 2.5 ml and 20 ml syringes, hypafix and duoderm tapes

  • Feeding chart

Weaning process

The Newborn Homecare team will visit whānau the day after discharge to assess the infants hydration and readiness to continue weaning. The weaning plan will be individualised depending on the infant’s feeding regime by the homecare nurse, with support from the infant’s discharging SMO.

Process

• Use the Newborn Services breast feeding top up codes

• Decreasing the top-up frequency or volume

• Implementing alternate NGT top-ups.

• Whānau to complete the Homecare Feeding Forms. This will provide information to base weaning decisions on and assess progress.

• Homecare nurse will assesses hydration every 48 hrs after a wean is made. This could be via video review if parents have a set of scales or via face to face appointment.

Any concerns regarding progress will be escalated to the discharging SMO. The infants lead SMO should be kept up to date with progress. If a baby still requires NGT feeds at 21 days (3 weeks post discharge), an outpatient SMO review is required. Discussion about referrals to the community dietitian, speech language therapist and Starship SMO to be considered by the NICU SMO at this time.

Note: If the discharging SMO is unavailable, please discuss with the infants lead SMO.