Crib-side studies help struggling newborns go home without feeding tubes

(COLUMBUS, Ohio) – A new strategy developed in the Neonatal and Infant Feeding Disorders Program at Nationwide Children's Hospital is helping premature infants and other newborns with severe swallowing difficulties learn to feed on their own. According to a study appearing in the February issue of the Journal of Pediatric Gastroenterology and Nutrition, physicians at Nationwide Children's were able to help 15 out of 20 infants with severe feeding difficulties and airway concerns learn to feed by mouth. Successful feeders were sent home without the need for feeding tubes.

These infants were referred to the Neonatal and Infant Feeding Disorders Program for evaluation and management of their severe feeding concerns. Previous research has shown that nearly two out of 10 babies experience difficulty feeding, often resulting in significant medical bills and extended hospital stays. In the United States, approximately 13 percent of all infants, and 26 percent of premature infants experience swallowing dysfunction.

Aside from the improved quality of life, this study resulted in an estimated savings of $1.8 million in health care costs for the participants related to gastric feeding tubes (G-tubes). It has been estimated that the health care costs for children on G-tubes is nearly $50,000 per patient for the first year, about the cost of one year's tuition at a major ivy-league university.

"Any infant that fails to feed orally is considered to have feeding difficulty," said Sudarshan Jadcherla, MD, FRCPI, DCH, AGAF, Nationwide Children's Hospital neonatologist and principal investigator in the Center for Perinatal Research, medical director of the Neonatal and Infant Feeding Disorders Program at Nationwide Children's and lead author of the study. Dr. Jadcherla is funded by the National Institutes of Health to study the mechanisms of feeding disorders in infants.

Symptoms of feeding difficulties include difficulty breathing, spluttering, coughing during and after feeds, aspiration, regurgitation, failure to coordinate sucking and swallowing with breathing, and irritability during feeds. These feeding difficulties can be seen in patients with systemic illness and may relate to gastrointestinal, esophageal, behavioral, neurological, structural, and cardiorespiratory origins.

Despite the range of symptoms or causes of feeding difficulty, the desired objective is the same said Dr. Jadcherla, also an associate professor of Pediatrics at The Ohio State University College of Medicine. "For every baby diagnosed with a feeding disorder, the ultimate goal is full oral feeds."

Teaching newborns to transition early to oral feeds is imperative. "We can make the greatest impact during the first few months of their lives because this is when the largest transformation is going on in their behaviors and feeding skills," said Dr. Jadcherla. If infants don't develop appropriate pathways to feeding skills early on, it is less likely that they will develop them during their lifetime.

The babies that learned to feed orally in the study did so through approaches developed at the Newborn and Infant Disorders Program at Nationwide Children's Hospital. The program accelerates newborns' feeding skills through individualized, crib-side studies. To determine the underpinning of each newborn's feeding problem, the team uses a special feeding tube with advanced sensors to capture the rhythm of muscular contractions throughout the entire aero-digestive tract, beginning with the mouth and ending beyond the stomach. The signals from the tube are translated into a graphic form and are evaluated. Data is then shared with a multidisciplinary clinical team that collaborates to execute the individualized strategies for delivering effective nutrition, based on the baby's individual needs.

In light of outcome data, this multidisciplinary program could serve as a model of care for newborns with feeding disorders and could lead to new understanding of how pediatric feeding disorders develop. "These diagnostic and therapeutic strategies that have evolved to improve feeding success may raise the health quality and lower the costs," said Dr. Jadcherla.