Development and Implementation of a Protocol for NICU Discharge With Nasogastric Tube Feedings: Successes, Barriers, and Lessons Learned.

Background: There is sufficient evidence to support safe discharge from the neonatal intensive care unit (NICU) with nasogastric tube (NGT) feedings when appropriate caregiver education, outpatient support, and feeding therapy are available.

Purpose: We sought to identify infants eligible for safe discharge with NGT feedings to reduce NICU length of stay and avert unnecessary surgical gastrostomy tube (GT) placement.

Method: A protocol with infant eligibility criteria for NICU discharge with NGT feedings was developed and implemented. A focus group was conducted to identify perceived successes, barriers and lessons learned.

Results: There was low uptake of the new protocol. Barriers to implementation included inconsistent protocol adoption by NICU providers, concerns about lack of outpatient support, and significant language barriers for non-English speaking families.

Implications: Outpatient multidisciplinary support is crucial to successfully implement home NGT feedings upon NICU discharge. A well-developed protocol provides eligibility standards and decision support.