Developing and Outreach Service - Potential Demand for Discharge on Home Tube Feeding of Infants in A Tertiary Surgical Neonatal Unit

Abstract

Objectives To determine the potential demand for an outreach service for infants who are medically fit for discharge but have extended hospital stay for establishing oral feeds. To determine breastfeeding rates at discharge and estimated cost savings of reducing length of stay. Methods A retrospective audit was performed in a tertiary surgical neonatal unit over a 4-month period in 2021. Inclusion criteria: all babies >34 weeks of corrected gestational age and >1.5 Kg who were medically fit for discharge but stayed in hospital while transitioning from nasogastric tube (NGT) feeding to oral feeds. Medically fit for discharge was defined as: tolerating 3-hourly feeds, >50% oral feeds, consistent gain weight, normothermic, self-ventilating in air and without any need for ongoing medical treatment. Data were collected using EPR, BadgerNet and reviewing the medical notes. Results Twenty patients met the inclusion criteria. Infants who were otherwise fit for discharge, but required NGT top-ups, had extended admission to the Special Care Baby Unit (SCBU) for 5.9 days +/- 2.9 days until they reached full oral feeds. Total extended length of stay for the 20 babies was 101 days. All babies were discharged on some breastmilk (mixed feeding) and 25% of them were exclusively on breast milk. Conclusion Many infants in the neonatal units have extended length of stay while they establish full oral feeds. NHS England and the Commissioning for Quality and Innovation Framework (CQUIN) support the need for implementation of outreach services for the neonatal units, which can provide community support, expedite early discharges, and reduce bed occupancy levels. Our study showed that approximately 60 babies per year, who have extended length of stay in our unit while establishing oral feeds, would benefit from having access to an outreach service. The length of the stay could be reduced by 300 SCBU days per year, with estimated cost savings around <= 120,000 per year. Discharge home on tube feeds will have a positive impact in the babies and their families, promoting establishment and continuation of breastfeeding and bonding. We aim to develop an outreach service which will facilitate, amongst others, early discharge of neonates on tube feeds, to continue the transition to oral feeds at home.