Kristina Nash

Objective: Feeding-tube weaning is conducted in both inpatient and outpatient settings, with significant logistical, financial, and structural barriers to both approaches. We sought to assess whether remote patient monitoring (RPM), using a mobile application, which would overcome many of these barriers, could be effective in helping patients tube wean. Methods: We prospectively enrolled patients with a feeding tube, aged 0–3 years. Enrolled families entered data daily into the remote application. Data were monitored by a nurse and reviewed weekly by a multidisciplinary team. A standard hunger provocation protocol was used, paired with medical, behavioral, oral motor, and nutrition interventions, as needed. We conducted a retrospective chart review to identify a comparison cohort. The chart review was collected first, then compared to the prospective, non-randomized trial of RPM tube weaning. Results: The chart review identified 141 children seen with a feeding tube from January 2023–June 2023. Of those, 17 children attempted a tube wean. The post-intervention group consisted of 38 children prospectively enrolled from the same clinic between November 2023–2024. In the pre-intervention group, 41% of the children (7/17) were successful in achieving all calories by mouth and 90% of children (34/38) in the post-intervention group were successful in tube weaning. Conclusions: RPM is a feasible and incredibly promising model for feeding-tube weaning in pediatric patients with a wide range of medical comorbidities, including patients with multiple comorbidities. RPM allowed for high-quality medical monitoring and for a dynamic intervention in response to patient data transferred to the medical team in real time.

Background: Evidence-based tube feeding (TF) weaning involves reducing the volume of tube feeds to induce hunger, with interdisciplinary monitoring to allow for proactive medical, nutritional, and behavioral intervention as needed. This can be done outpatient; however, the current standard of care requires a high degree of medical monitoring and care coordination, which can be challenging to implement. The CHAMP App is a mobile app designed for remote patient monitoring of children born with congenital heart conditions who are at high risk for medical morbidity and mortality. The CHAMP App remote patient monitoring program would be ideally suited to improve medical monitoring and care coordination. Objective: This study aims to determine the feasibility of adapting the CHAMP App for children ready to wean from TF. Methods: We used the Non-adoption, Abandonment, Scale-up, Spread, and Sustainability (NASSS) framework as a formative tool and conducted a case study beta test. Results: The level of complexity for the digital innovation’s adaptation supported a high likelihood of success for the TF population. Most issues were simple, such as expanding the types of data that could be entered into the app, and some were more complicated, for instance, training all relevant staff to use and maintain the technology. The case study beta test was conducted with “Greyson”, a 10-month old child weaning from TF (name changed for confidentiality). Once a week, the team reviewed the parent-entered data and communicated with Greyson’s parents, recommending a 25% reduction in tube feeding each week. With the CHAMP App facilitating 2-way communication between the family and the team, Greyson successfully transitioned from receiving 30% of his feeds orally and 70% via tube feeding to 100% oral feedings over the course of 1 month in a home setting. Conclusions: The CHAMP App is likely to be incredibly valuable in TF weaning. The NASSS framework helped identify key considerations for adapting the CHAMP App for TF weaning at a Midwestern children’s hospital. Interviews with the health care team highlighted issues like data entry expansion and staff training. The framework confirmed TF weaning as a suitable application with no major barriers. The CHAMP App successfully supported a test patient, Greyson, in weaning from his feeding tube. It may improve access, communication efficiency, and satisfaction among families and health care teams while reducing costs and enhancing safety monitoring. The app could also make TF weaning more accessible to families with lower health literacy.