title: Impact of personalized feeding program in 100 NICU infants: pathophysiology-based approach for better outcomes.
abstract: OBJECTIVE
  In neonatal intensive care unit infants referred for home-tube feeding methods, we evaluated the effect of an innovative diagnostic and management approach on feeding outcomes at discharge and 1 year, by comparing data from historical controls; we hypothesized that clinical and aerodigestive motility characteristics at evaluation were predictive of feeding outcomes at discharge; we assessed the economic impact of feeding outcomes.
  
  
  METHODS
  Patients (N = 100) who were referred for development of long-term feeding management strategy at 46.4 ± 13.1 weeks' postmenstrual age were compared with 50 historical controls that received routine care. The focused approach included swallow-integrated pharyngoesophageal manometry, individualized feeding strategy, and prospective follow-up. Feeding success was defined as ability to achieve oral feedings at discharge and 1 year. Motility characteristics were evaluated in relation to feeding success or failure at discharge.
  
  
  RESULTS
  Higher feeding success was achieved in the innovative feeding program (vs historical controls) at discharge (51% vs 10%, P < 0.0001) and at 1 year (84.3% vs 42.9%, P < 0.0001), at a reduced economic burden (P < 0.05). Contributing factors to the innovative program's feeding success (vs feeding failure) were earlier evaluation and discharge (both P < 0.05), greater peristaltic reflex-frequency to provocation (P < 0.05), normal pharyngeal manometry (P < 0.05), oral feeding challenge success (P < 0.05), and suck-swallow-breath-esophageal swallow sequence (P < 0.05). Probability of feeding success demonstrated a prediction rate of 79.6%.
  
  
  CONCLUSIONS
  Short-term and long-term feeding outcomes in complex neonates can be significantly improved with innovative feeding strategies at a reduced cost. Clinical and aerodigestive motility characteristics were predictive of outcomes.
authors.affiliation: Neonatal and Infant Feeding Disorders Program, Center for Perinatal Research, Research Institute at Nationwide Children's Hospital, Section of Neonatology, Ohio State University College of Medicine, Columbus, OH 43205, USA. sudarshan.jadcherla@nationwidechildrens.org
authors.forename: Sudarshan R
authors.initials: SR
authors.lastname: Jadcherla
authors.forename: Juan
authors.initials: J
authors.lastname: Peng
authors.forename: Rebecca
authors.initials: R
authors.lastname: Moore
authors.forename: Jason
authors.initials: J
authors.lastname: Saavedra
authors.forename: Edward
authors.initials: E
authors.lastname: Shepherd
authors.forename: Soledad
authors.initials: S
authors.lastname: Fernandez
authors.forename: Steven H
authors.initials: SH
authors.lastname: Erdman
authors.forename: Carlo
authors.initials: C
authors.lastname: DiLorenzo
mesh_terms: D016022:Case-Control Studies; D003679:Deglutition / Q000502:physiology; D004750:Enteral Nutrition / Q000191:economics; D004947:Esophagus / Q000502:physiology; D005248:Feeding Methods / Q000191:economics; D005260:Female; D005500:Follow-Up Studies; D005769:Gastrointestinal Motility; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D008297:Male; D008365:Manometry / Q000379:methods; D010528:Peristalsis; D015397:Program Evaluation / Q000191:economics; D011446:Prospective Studies; D012119:Respiration; D013391:Sucking Behavior / Q000502:physiology*