title: Feeding Methods at Discharge Predict Long-Term Feeding and Neurodevelopmental Outcomes in Preterm Infants Referred for Gastrostomy Evaluation.
abstract: To test the hypothesis that oral feeding at first neonatal intensive care unit discharge is associated with less neurodevelopmental impairment and better feeding milestones compared with discharge with a gastrostomy tube (G-tube).
  
  
  
  We studied outcomes for a retrospective cohort of 194 neonates <37 weeks' gestation referred for evaluation and management of feeding difficulties between July 2006 and July 2012. Discharge milestones, length of hospitalization, and Bayley Scales of Infant Development-Third Edition scores at 18-24 months were examined. χ2, Mann-Whitney U, or t tests and multivariable logistic regression models were used.
  
  
  
  A total of 60% (n = 117) of infants were discharged on oral feedings; of these, 96% remained oral-fed at 1 year. The remaining 40% (n = 77) were discharged on G-tube feedings; of these, 31 (40%) remained G-tube dependent, 17 (22%) became oral-fed, and 29 (38%) were on oral and G-tube feedings at 1 year. Infants discharged on a G-tube had lower cognitive (P <.01), communication (P = .03), and motor (P <.01) composite scores. The presence of a G-tube, younger gestation, bronchopulmonary dysplasia, or intraventricular hemorrhage was associated significantly with neurodevelopmental delay.
  
  
  
  For infants referred for feeding concerns, G-tube evaluations, and feeding management, the majority did not require a G-tube. Full oral feeding at first neonatal intensive care unit discharge was associated with superior feeding milestones and less long-term neurodevelopmental impairment, relative to full or partial G-tube feeding. Evaluation and feeding management before and after G-tube placement may improve long-term feeding and neurodevelopmental outcomes.
authors.affiliation: Innovative Feeding Disorders Research Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Division of Neonatology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH. Electronic address: Sudarshan.Jadcherla@Nationwidechildrens.org.
authors.forename: Sudarshan R
authors.initials: SR
authors.lastname: Jadcherla
authors.affiliation: Innovative Feeding Disorders Research Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
authors.forename: Tanvi
authors.initials: T
authors.lastname: Khot
authors.affiliation: Innovative Feeding Disorders Research Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH.
authors.forename: Rebecca
authors.initials: R
authors.lastname: Moore
authors.affiliation: Innovative Feeding Disorders Research Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Division of Pediatric Cardiology, Saint Louis University School of Medicine, St Louis, MO.
authors.forename: Manish
authors.initials: M
authors.lastname: Malkar
authors.affiliation: Innovative Feeding Disorders Research Program, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Division of Neonatology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH.
authors.forename: Ish K
authors.initials: IK
authors.lastname: Gulati
authors.affiliation: Center for Perinatal Research, The Research Institute at Nationwide Children's Hospital, Columbus, OH; Division of Neonatology, Department of Pediatrics, The Ohio State University College of Medicine, Columbus, OH.
authors.forename: Jonathan L
authors.initials: JL
authors.lastname: Slaughter
mesh_terms: D015331:Cohort Studies; D002658:Developmental Disabilities / Q000453:epidemiology* / Q000503:physiopathology; D004435:Eating / Q000502:physiology; D004750:Enteral Nutrition / Q000379:methods; D005248:Feeding Methods; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods*; D005865:Gestational Age; D006801:Humans; D007231:Infant, Newborn; D007234:Infant, Premature; D007363:Intensive Care Units, Neonatal; D016015:Logistic Models; D008134:Long-Term Care; D008297:Male; D015999:Multivariate Analysis; D010351:Patient Discharge; D011379:Prognosis; D012189:Retrospective Studies; D018709:Statistics, Nonparametric; D016896:Treatment Outcome
keywords: aerodigestive; feeding difficulties; gastrostomy; infants; neurodevelopmental outcomes