Background: Oral feeding dysfunction is common in infants with congenital heart disease (CHD). We initiated a program to allow infants with CHD to be discharged home with nasogastric tube (NGT) feeds and close outpatient monitoring by a dedicated nurse and dietitian.

Objective: We aimed to assess the safety of home NGT and identify factors associated with successful wean to full oral intake (PO) as an outpatient.

Design/Methods: This is a prospective cohort study of infants with CHD requiring surgical palliation or repair in the home NGT program at Children’s Hospital Los Angeles from 10/1/17 to 5/7/22. Demographics, CHD type, PO % at discharge, and complications requiring emergency (ED) visit or re-admission were evaluated. Outcome data included full PO by study end and home NGT duration. ANOVA was used to examine characteristics of those who achieved full PO, and multivariate logistic regression explored relationships between clinical factors and successful wean off tube feeds.

Results: Of 72 CHD patients followed for home NGT, 2 died unrelated to NGT. Of 70 remaining, 56% were female, 74% full term. A majority had cyanotic CHD (57%) and 27% had single ventricles. Cardiac intervention prior to home NGT included 42% with palliative and 41% with complete surgical repair; 17% had unrepaired CHD. At study end, 77% achieved full PO feeds. Average duration of home NGT was 128 days (SD 129 days). Complications were infrequent: 19 ED visits for 7 patients (10% of patients) & 3 feeding readmissions (17% of patients). There were no aspiration or other critical events. Factors associated with successful wean off NGT included percent PO at time of discharge, with a 3% increase in the odds of successful wean off tube feeds with every 1% increase in PO. Infant sex, prematurity, and single ventricle or cyanotic CHD subtype did not predict full PO. Infants who achieved full PO intake were more likely to be unrepaired or fully repaired CHD than palliated CHD (p=0.02) and 90% of the unrepaired infants got to full PO feeding.

Conclusion: Home NGT is a safe option for infants with complex CHD to optimize nutrition and shorten hospital stay. Full PO success was achieved in most patients, predicted by more oral intake at home NGT initiation. Infants who were unrepaired and those with fully repaired CHD were more likely to achieve full PO than those with palliated CHD. Our program was successful with few NGT readmissions, no serious complications, and a novel nurse/dietitian led model.