From the Research
For neonates on CPAP, orogastric (OG) tubes are generally preferred over nasogastric (NG) tubes due to their ability to provide proper gastric decompression while minimizing airway resistance and potential complications, as supported by the most recent and highest quality study available 1. When considering the use of OG versus NG tubes in neonates on CPAP, several factors come into play, including the potential impact on respiratory function, the risk of complications, and the effectiveness of gastric decompression.
- The study by 1 found that nasogastric feeding reduced the time to achieve full enteral feeds compared to orogastric feeding, but increased episodes of bradycardia and desaturation, highlighting the need for cautious interpretation and consideration of individual patient needs.
- In contrast, the use of OG tubes has been shown to avoid complications such as nasal trauma, septal injury, and competition for space with CPAP prongs in the small neonatal nasal passages, making them a preferred choice for neonates requiring CPAP.
- The recommended approach is to place an OG tube (typically 5-8 French size depending on the infant's weight) and secure it properly to the cheek with hypoallergenic tape, checking for proper placement by aspirating gastric contents and confirming position via auscultation or X-ray verification when first placed.
- Regular assessment of tube patency and repositioning as needed will help minimize oral trauma during prolonged use, and the use of OG tubes can help prevent abdominal distension, which is common during CPAP therapy due to gas flow into the stomach.
- While older studies such as 2 and 3 provide some insight into the effects of NG and OG tubes on neonates, the most recent and highest quality study 1 should be prioritized when making decisions about tube placement in this population.