Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2015 Jul 8;2015(7):CD003743.
doi: 10.1002/14651858.CD003743.pub2.

Early discharge with home support of gavage feeding for stable preterm infants who have not established full oral feeds

Carmel T Collins  1 , Maria Makrides, Andrew J McPhee
Affiliations

Early discharge with home support of gavage feeding for stable preterm infants who have not established full oral feeds

Carmel T Collins et al. Cochrane Database Syst Rev. .

Update in

Abstract

Background: Early discharge of stable preterm infants still requiring gavage feeds offers the benefits of uniting families sooner and reducing healthcare and family costs compared with discharge home when on full sucking feeds. Potential disadvantages of early discharge include increased care burden for the family and risk of complications related to gavage feeding.

Objectives: To determine the effects of a policy of early discharge of stable preterm infants with home support of gavage feeding compared with a policy of discharge of such infants when they have reached full sucking feeds.We planned subgroup analyses to determine whether safety and efficacy outcomes are altered by the type of support received (outpatient visits vs home support) or by the maturity of the infants discharged (gestational age ≤ 28 weeks at birth or birth weight ≤ 1000 grams).

Search methods: We used the standard search strategy of the Cochrane Neonatal Review Group, together with searches of the Cochrane Central Register of Controlled Trials (CENTRAL; 2015, Issue 3), the Cumulative Index to Nursing and Allied Health Literature (CINAHL) (1982 to March 2015), EMBASE (1980 to March 2015) and MEDLINE (1950 to March 2015). We found no new trials.

Selection criteria: We included all randomised and quasi-randomised trials among infants born at < 37 weeks and requiring no intravenous nutrition at the point of discharge. Trials were required to compare early discharge home with gavage feeds and healthcare support versus later discharge home when full sucking feeds were attained.

Data collection and analysis: Two review authors independently assessed trial quality and extracted data. We conducted study authors for additional information. We performed data analysis in accordance with the standards of the Cochrane Neonatal Review Group.

Main results: We included in the review data from one quasi-randomised trial with 88 infants from 75 families. Infants in the early discharge programme with home gavage feeding had a mean hospital stay that was 9.3 days shorter (mean difference (MD) -9.3, 95% confidence interval (CI) -18.49 to -0.11) than that of infants in the control group. Infants in the early discharge programme also had lower risk of clinical infection during the home gavage period compared with those in the control group spending corresponding time in hospital (risk ratio 0.35, 95% CI 0.17 to 0.69). No significant differences were noted between groups in duration and extent of breast feeding, weight gain, re-admission within the first 12 months post discharge from the home gavage programme or from hospital, scores reflecting parental satisfaction or overall health service use.

Authors' conclusions: Experimental evidence on the benefits and risks for preterm infants of early discharge from hospital with home gavage feeding compared with later discharge upon attainment of full sucking feeds is limited to the results of one small quasi-randomised controlled trial. High-quality trials with concealed allocation, complete follow-up of all randomly assigned infants and adequate sample size are needed before practice recommendations can be made.

PubMed Disclaimer

Conflict of interest statement

None known.

Figures

1.1
1.1. Analysis
Comparison 1 Early discharge to home gavage programme versus later discharge on full sucking feeds, Outcome 1 Stopped any breast feeding by different times (proportion of infants).
1.2
1.2. Analysis
Comparison 1 Early discharge to home gavage programme versus later discharge on full sucking feeds, Outcome 2 Stopped fully breast feeding at different times (proportion of infants).
1.3
1.3. Analysis
Comparison 1 Early discharge to home gavage programme versus later discharge on full sucking feeds, Outcome 3 Weight gain (g/d) on discharge from home gavage programme (exp) or discharge from hospital (control).
1.4
1.4. Analysis
Comparison 1 Early discharge to home gavage programme versus later discharge on full sucking feeds, Outcome 4 Length of hospitalisation.
1.5
1.5. Analysis
Comparison 1 Early discharge to home gavage programme versus later discharge on full sucking feeds, Outcome 5 Infants with 1 or more hospital re‐admissions.
1.6
1.6. Analysis
Comparison 1 Early discharge to home gavage programme versus later discharge on full sucking feeds, Outcome 6 Infants with 1 or more adverse events.
1.7
1.7. Analysis
Comparison 1 Early discharge to home gavage programme versus later discharge on full sucking feeds, Outcome 7 Parental satisfaction on discharge from home gavage programme (exp) or discharge from hospital (control).
1.8
1.8. Analysis
Comparison 1 Early discharge to home gavage programme versus later discharge on full sucking feeds, Outcome 8 Parental anxiety on discharge from home gavage programme (exp) or discharge from hospital (control).
1.9
1.9. Analysis
Comparison 1 Early discharge to home gavage programme versus later discharge on full sucking feeds, Outcome 9 Health service use post discharge from home gavage programme (exp) or from hospital (control).
See this image and copyright information in PMC

Update of

References

References to studies included in this review

Örtenstrand 1999 {published and unpublished data}
    1. Örtenstrand A, Waldenström U, Winbladh B. Early discharge of preterm infants needing limited special care, followed by domiciliary nursing care. Acta Paediatrica 1999;88(9):1024‐30. - PubMed
    1. Örtenstrand A, Winbladh B, Nordström G, Waldenström U. Early discharge of preterm infants followed by domiciliary nursing care: parents' anxiety, assessment of infant health and breastfeeding. Acta Paediatrica 2001;90(10):1190‐5. - PubMed

References to studies excluded from this review

Bhargava 1980 {published data only}
    1. Bhargava SK, Kumari S, Bawa S, Choudhury P, Lall UB. Early discharge of infants with weight of 1800 g. or less. Indian Pediatrics 1980;17(5):425‐9. - PubMed
Brooten 1986 {published data only}
    1. Brooten D, Kumar S, Brown LP, Butts P, Finkler SA, Bakewell‐Sachs S, et al. A randomized clinical trial of early hospital discharge and home follow‐up of very‐low‐birth‐weight infants. New England Journal of Medicine 1986;315(15):934‐9. - PubMed
Casiro 1993 {published data only}
    1. Casiro OG, McKenzie ME, McFayden L, Shapiro C, Seshia MM, MacDonald N, et al. Earlier discharge with community‐based intervention for low birth weight infants: a randomized trial. Pediatrics 1993;92(1):128‐34. - PubMed
Charpak 1997 {published data only}
    1. Charpak N, Ruiz‐Peláez JG, Figueroa de CZ, Charpak Y. Kangaroo mother versus traditional care for newborn infants <=2000 grams: a randomized, controlled trial. Pediatrics 1997;100(4):682‐8. - PubMed
Cruz 1997 {published data only}
    1. Cruz H, Guzman N, Rosales M, Bastidas J, Garcia J, Hurtado I, et al. Early hospital discharge of preterm very low birth weight infants. Journal of Perinatology 1997;17(1):29‐32. - PubMed
Davies 1979 {published and unpublished data}
    1. Davies DP, Haxby V, Herbert S, McNeish AS. When should pre‐term babies be sent home from neonatal units?. The Lancet 1979;1(8122):914‐5. - PubMed
Dillard 1973 {published and unpublished data}
    1. Dillard RG, Korones SB. Lower discharge weight and shortened nursery stay for low‐birth‐weight infants. The New England Journal of Medicine 1973;288(3):131‐3. - PubMed
Finello 1998 {published data only}
    1. Finello KM, Litton KM, deLemos R, Chan LS. Very low birth weight infants and their families during the first year of life: comparisons of medical outcomes based on after care services. Journal of Perinatology 1998;18(5):365‐71. - PubMed
Gibson 1998 {published data only}
    1. Gibson E, Medoff‐Cooper B, Nuamah IF, Gerdes J, Kirkby S, Greenspan J. Accelerated discharge of low birth weight infants from neonatal intensive care: a randomized, controlled trial. The Early Discharge Study Group. Journal of Perinatology 1998;18(6 Pt 2 Suppl):S17‐S23. - PubMed
Lefebvre 1982 {published data only}
    1. Lefebvre F, Veilleux A, Bard H. Early discharge of low birthweight infants. Archives of Disease in Childhood 1982;57(7):511‐3. - PMC - PubMed
Puerto 1993 {published and unpublished data}
    1. Martin Peurto MJ, Gomez Castillo E, Pascual Patrao M, Pallas Alonso C. Early discharge of low‐birth‐weight neonates. 5‐year experience [Alta precoz en recien nacidos de bajo peso. Experiencia de 5 anos]. Anales Espanoles de Pediatria 1993;38(1):20‐4. - PubMed

Additional references

AAP 1998
    1. American Academy of Pediatrics. Committee on Fetus and Newborn. Hospital discharge of the high‐risk neonate ‐ proposed guidelines. Pediatrics 1998;102(2 Pt 1):411‐7. - PubMed
Evanochko 1996
    1. Evanochko C, Jancs‐Kelley S, Boyle R, Fox M, Molesky M, Byrne P. Facilitating early discharge from the NICU: the development of a home gavage program and neonatal outpatient clinic. Neonatal Network 1996;15(8):44. - PubMed
Evans 1988
    1. Evans ID. Tubefeeding newborn babies at home. Journal of the Royal Army Medical Corps 1988;134(3):149‐50. - PubMed
Higgins 2011
    1. Higgins JPT, Green S (editors). Cochrane Handbook for Systematic Reviews of Interventions Version 5.1.0. The Cochrane Collaboration, 2011.
Labbok 1990
    1. Labbok M, Krasovek K. Toward consistency in breastfeeding definitions. Studies in Family Planning 1990;21(4):226‐30. - PubMed
Laddem 1992
    1. Laddem M, Damato E. Parenting and supportive programs. NAACOG's Clinical Issues in Perinatal and Women's Health Nursing 1992;3(1):174‐87. - PubMed
Meerlo‐Habing 2009
    1. Meerlo‐Habing ZE, Kosters‐Boes EA, Klip H, Brand PL. Early discharge with tube feeding at home for preterm infants is associated with longer duration of breast feeding. Archives of Disease in Childhood. Fetal & Neonatal Edition 2009;94(4):F294‐7. - PubMed
Revman 2012 [Computer program]
    1. The Cochrane Collaboration. Review Manager (RevMan) [Computer program]. Version 5.3. Copenhagen: The Nordic Cochrane Centre: The Cochrane Collaboration, 2012.
Sturm 2005
    1. Sturm LD. Implementation and evaluation for a home gavage program for preterm infants. Neonatal Network 2005;24(4):21‐5. - PubMed
Swanson 1997
    1. Swanson SC, Naber MM. Neonatal integrated home care: nursing without walls. Neonatal Network 1997;16(7):33‐8. - PubMed
Wakefield 1994
    1. Wakefield J, Ford L. Nasogastric tube feeding and early discharge. Paediatric Nursing 1994;6:18‐9.

References to other published versions of this review

Collins 2003
    1. Collins CT, Makrides M, McPhee AJ. Early discharge with home support of gavage feeding for stable preterm infants who have not established full oral feeds. Cochrane Database of Systematic Reviews 2003, Issue 4. [DOI: 10.1002/14651858.CD003743] - DOI - PubMed

Publication types