From the Research
For neonates on CPAP, orogastric (OG) tubes are generally preferred over nasogastric (NG) tubes due to the potential for NG tubes to increase airway resistance and compromise CPAP therapy effectiveness. This recommendation is based on the most recent and highest quality study available, which highlights the importance of minimizing airway resistance in neonates on CPAP 1. The study found that nasogastric feeding reduced the time to achieve full enteral feeds compared to orogastric feeding, but increased episodes of bradycardia and desaturation. However, when considering the specific context of CPAP therapy, the potential benefits of OG tubes in reducing airway resistance and improving CPAP effectiveness outweigh the potential benefits of NG tubes in terms of feeding performance.
Key Considerations for OG Tube Placement
- Use an appropriately sized tube based on the neonate's weight (typically 5-8 Fr)
- Measure insertion length from the corner of the mouth to the earlobe and then to the midpoint between the xiphoid process and umbilicus
- Secure the tube properly to prevent dislodgement
- Verify proper placement by aspirating gastric contents and checking pH, or by radiographic confirmation if needed
- Regularly assess for complications such as oral irritation or pressure injuries
Rationale for OG Tube Preference
- Neonates are obligate nasal breathers, and NG tubes can increase airway resistance and compromise CPAP therapy effectiveness
- The presence of an NG tube in one nostril can obstruct nasal airflow, increase work of breathing, and may lead to higher CPAP pressure requirements or treatment failure
- OG tubes can help minimize airway resistance and improve CPAP effectiveness, leading to better outcomes for neonates on CPAP therapy 2, 3
Special Considerations
- In rare situations where an OG tube cannot be placed or maintained, an NG tube may be considered, but this should be discussed with the neonatal care team to weigh the risks against benefits
- The decision to use an NG or OG tube should be made on a case-by-case basis, taking into account the individual neonate's needs and medical status 4, 5