Orogastric Tube Insertion in Extremely Low Birth-Weight Infants

Abstract

Background: 

Orogastric (OG) tube insertion is a frequent practice performed by nurses in the neonatal intensive care unit (NICU). Combining the nose–ear–mid-umbilicus (NEMU) method with a birth weight (BW)–based method to determine optimal insertion length of OG tubes could reduce misplacement in extremely low birth-weight (ELBW) infants.

Purpose: 

The objective of this study was to determine whether combining the NEMU method with a BW-based method to determine insertion length of OG tubes reduces misplacement of OG tubes in ELBW infants younger than 6 hours.

Methods: 

The study included 129 ELBW infants in the NICU younger than 6 hours. We compared the frequency of OG tube misplacements in ELBW infants during 2 different time periods. In period I, the insertion length of OG tubes was estimated with the NEMU method alone. In period II, the insertion length of OG tubes was estimated by combining the NEMU method with a BW-based method. OG tubes were considered misplaced if the tip was above the diaphragm (high) or near the pylorus (low) in radiographs obtained after placement.

Results: 

Infants who had OG tubes placed by combining both methods were less likely to have low OG tubes (53% in period I vs 34% in period II; P < .05). The BW-based method alone predicted optimal OG tube insertion length in 57 of 89 infants (64%).

Implications for Practice and Research: 

Combining the NEMU method with the BW-based method increases the probability of optimal OG tube placement in ELBW infants. Additional studies across multiple centers would validate the diagnostic accuracy of this method.

Video abstract available athttps://journals.lww.com/advancesinneonatalcare/Pages/videogallery.aspx.