Key messages

• For stable preterm babies (born before 37 weeks of pregnancy) who are not yet having all feeds at the breast or bottle (all suck or oral feeds), we found very uncertain evidence that early discharge with home support of gavage (tube) feeding versus later discharge when they are fully suck feeding:

  • may result in little to no difference in weight gain, breastfeeding at discharge from home support/hospital and three months later, and the need to be readmitted to hospital up to 12 months later; and

  • may reduce the risk of respiratory infections up to discharge from home support/hospital, but may result in little to no difference in the use of antibiotics given directly into a vein.

• Larger studies with high-quality methods are needed to determine the benefits and harms of this approach, including in diverse settings and populations.

Why might early discharge with home support of gavage feeding be important?

Babies born preterm (before 37 weeks of pregnancy) often need help to establish feeding, and are fed initially via a tube passed through the nose or mouth and into the stomach (known as gavage feeding). Discharge from hospital usually occurs when they no longer need gavage feeds and are on full sucking feeds and gaining weight appropriately. Early discharge of babies who are stable but still need gavage feeds might unite families sooner and have positive effects on parent-infant attachment, parent well-being, and infant development. These babies may graduate to full sucking feeds at home if the family receives some support. In addition, early discharge might reduce costs for families and the healthcare system. However, this approach may present a burden for the family and increase complications during the transition from tube feeding.

What did we want to find out?

We wanted to find out if early discharge with home support of gavage feeding is better than later discharge on full sucking feeds for stable preterm babies.

We were interested in the effects of early discharge with support on: how long it takes for babies to reach full sucking feeds; how much weight babies gain; breastfeeding on discharge from home support/hospital and three months later; infection up to discharge from home support/hospital; development at 12 months or later; and need for readmission to hospital up to 12 months after discharge from home support/hospital.

What did we do?

We searched for studies that looked at the benefits and harms of early discharge with home support of gavage feeding for stable preterm babies and their families compared with later discharge on full sucking feeds. We summarised the results and rated our confidence in the evidence based on factors such as study methods and size.

What did we find?

We found only one study conducted in Sweden from 1992 to 1994 and involving 88 babies from 75 families. The study looked at early discharge with home support of gavage feeding compared with later discharge on full sucking feeds for babies born preterm who were expected to need additional care for at least another week. For different results, information was available for 82 to 88 of the babies from this study.

Compared with later discharge on full sucking feeds, early discharge with home support of gavage feeding may have little or no effect on:

• weight gain for babies (average per day from study entry to discharge from home support/hospital);

• stopping any breastfeeding and fully breastfeeding at discharge from home support/hospital and three months later;

• the use of antibiotics given directly into a vein; and

• the need for readmission to hospital up to 12 months after discharge from home support/hospital.

Early discharge with support versus later discharge may reduce the risk of respiratory infections (diagnosed based on symptoms, not laboratory tests) for babies up to discharge from home support/hospital.

The study did not examine the time taken for babies to reach full sucking feeds or development at 12 months or later.

We found two other studies that might be included in a future update of this review. One study is finished but not yet published. We do not know whether the other study is completed because the study authors have yet to reply to our request for information.

What are the limitations of the evidence?

We are not confident in the evidence because it is based on a single study that included few infants, because the method for assigning babies to one group or the other was not truly random, and because the families and clinicians knew which group the babies had been assigned to.

The results of further research could differ from and change the results of this review.

How up-to-date is this evidence?

This review updates our previous 2015 review. The evidence is current to 30 May 2024.