Oral Feeding Outcome in Infants with a Tracheostomy

• Published in: Journal of pediatric nursing 2017-03, Vol.33, p.70-75
• Main Authors: Joseph, Rachel A., Evitts, Paul, Bayley, Elizabeth W., Tulenko, Christy
• Format: Article
• Language: English
• Subjects: Administration, Oral; Child Development; Databases, Factual; Enteral Nutrition - methods; Feeding Behavior; feeding outcomes; Female; Follow-Up Studies; Humans; Infant; Infant, Newborn; Infant, Premature; Intensive Care Units, Pediatric; Length of Stay; Male; NICU; Nursing; Patient Discharge; pediatric; Retrospective Studies; Risk Assessment; tracheostomy; Tracheostomy - methods; Tracheostomy - statistics & numerical data
• ISSN: 0882-5963; 1532-8449
• DOI: 10.1016/j.pedn.2016.12.012

Purpose: Currently, there is a lack of evidence-based guidelines on the proper protocol for feeding infants with a tracheostomy in the neonatal intensive care unit (NICU). The purpose of this study was to provide preliminary insight into the outcomes of these infants in one mid-Atlantic pediatric hospital. Design and Methods: Retrospective and descriptive. The study team reviewed 114 patient records, 42 of which met the inclusion criteria. Data were organized based on: 1) general demographics and history; b) feeding-related variables at multiple points; c) speech-related variables, including assessments and swallowing studies; d) respiratory variables at multiple points; and, e) discharge data. Other variables included birth-related information, ventilation settings and feeding modifications. Results: Infants were placed into three groups at discharge based on feeding outcomes. Forty-three percent were discharged on full oral feeds, 38% on combined oral and gavage, and 19% of infants were discharged on full gavage feeds. Informal analysis showed that all three categories of infants gained weight during hospitalization, different PEEP pressures and different lengths of hospitalization were observed among the groups, and infant characteristics (e.g., APGAR, gestational ages) were similar across groups. Conclusions: Overall results provide insight into factors that may be predictive of feeding status at discharge for infants with a tracheostomy in an NICU. Practical Implications: Results of this study can provide important insight into the feeding outcomes of infants in a NICU with a tracheostomy and can hopefully lead to additional research to help determine the most efficacious procedures for feeding this patient population. •There is a lack of evidence-based guidelines on feeding infants with a tracheostomy in a NICU.•Prolonged intubation appears to impede the development of oral feeding skills in infants with a tracheostomy.•Gestational age may not play a role with feeding outcomes.•Most infants were discharged on either full oral or combined oral and gavage feeds.•Infants who were discharged on full gavage feeds required longer hospitalization times than the other two groups.