From the Research
For neonates on CPAP, orogastric (OG) tubes are generally preferred over nasogastric (NG) tubes. This recommendation is based on the most recent and highest quality study available, which suggests that OG tubes do not increase intra-gastric pressures and are associated with improved respiratory outcomes in neonates receiving CPAP support 1. The use of OG tubes allows for gastric decompression while keeping the nasal passages completely free for CPAP delivery, which is particularly important in neonates who are obligate nasal breathers.
When inserting an OG tube in a neonate, it is essential to use an appropriately sized tube (typically 5-8 Fr depending on the infant's size) and secure it properly to prevent dislodgement. Verification of placement can be done by aspirating gastric contents and checking pH (should be acidic, typically <5.5) or by radiographic confirmation if needed. The tube should be flushed with small amounts of air before and after feedings to maintain patency. Monitoring for complications such as oral irritation, tube displacement, or feeding intolerance is also crucial.
Key considerations for the use of OG tubes in neonates on CPAP include:
- Respiratory benefits: OG tubes do not compromise the effectiveness of CPAP therapy and may improve respiratory outcomes 2.
- Gastric decompression: OG tubes allow for effective gastric decompression while keeping the nasal passages free for CPAP delivery.
- Potential complications: Monitor for oral irritation, tube displacement, or feeding intolerance, and take steps to mitigate these risks.
Overall, the use of OG tubes in neonates on CPAP is supported by the available evidence and is recommended as the preferred approach for gastric decompression and enteral feeding in this population.