Published in the April 2026 issue of the ISHA Voice.
Article: Development and Implementation of a Protocol for NICU Discharge with Nasogastric Tube Feedings
Citation: Dozier-Lineberger, M., Orth, E., Hueckel, R., & Brandon, D. (2025). Development and Implementation of a Protocol for NICU Discharge With Nasogastric Tube Feedings: Successes, Barriers, and Lessons Learned. Advances in Neonatal Care : Official Journal of the National Association of Neonatal Nurses, 10.1097/ANC.0000000000001261. https://doi.org/10.1097/ANC.0000000000001261
Summary:
Summary written by Anna Manilla, MS, CCC-SLP, CLC
Current literature supports that when specific criteria are applied, many infants discharged from the neonatal intensive care unit (NICU) with nasogastric tube (NGT) feedings can achieve full oral feeding within three months of discharge. This article explores discharge from the NICU with NGT feedings across two clinical sites: (1) a 45-bed level III NICU in an urban area of southeastern United States, and (2) an outpatient feeding clinic within the same health system as the NICU.
Discharge criteria include the following:
- Stable thermoregulation in an open crib for a minimum of 72 hours.
- No clinically significant bradycardia for 5 days.
- No apnea for 7 days.
- Adequate weight gain to maintain or exceed current percentile.
- Parent/caregiver NGT education provided by NICU RN staff and documented in chart.
- Written feeding plan for discharge as determined by the Neonatology team.
- Infant tolerates bolus tube feeds and/or continuous overnight feeds (no 240hour continuous feeds).
- Documentation of nipple used for bottle feeding.
The primary barrier to implementation identified in the study was low utilization of the infant eligibility criteria which was influenced by providers’ prior experiences and their perceived ability to provide adequate outpatient follow-up. As noted by Dozier-Lineberger et al., “The inconsistent criteria used among NICU providers was a barrier to identification of eligible infants and ultimate discharge with NGTs”.
Proposed next steps include establishing greater consensus and provider buy-in among NICU clinicians to support earlier introduction of home NGT feedings during hospitalization. Earlier exposure may improve caregiver comfort and acceptance of home NGT feeding. Additionally, expanding outpatient support services may enhance continuity of care and improve long-term feeding outcomes.