From the Guidelines
Nasogastric (NG) tubes can be used instead of orogastric (OG) tubes in infants of any age, as long as the insertion is done by experienced staff to reduce the risk of oesophageal damage. The decision to use an NG tube should be based on the individual infant's needs and condition, taking into account the subtype of epidermolysis bullosa (EB), the presence and severity of oral and oesophageal mucosal lining fragility, and tolerance of feeds 1.
When considering the use of NG tubes, it is essential to prioritize the infant's safety and comfort. NG tubes are preferred over OG tubes due to increased OG tube movement against the oral mucosal lining, which can cause damage and discomfort 1.
Key considerations for NG tube insertion include:
- Using experienced staff for insertion and monitoring to minimize the risk of oesophageal damage 1
- Inserting the tube with proper lubrication to reduce the risk of oesophageal trauma 1
- Securing the NG tube with a low-adherent film contact layer and full-adherent tape to prevent skin irritation and ensure the tube remains in place 1
- Monitoring the infant's condition and adjusting the feeding plan as needed to optimize nutrition and minimize complications 1
Ultimately, the decision to use an NG tube instead of an OG tube should be made on a case-by-case basis, taking into account the individual infant's needs and condition, and prioritizing their safety, comfort, and nutritional well-being.
From the Research
Nasogastric Tube Usage in Infants
- The decision to use a nasogastric (NG) tube instead of an orogastric (OG) tube in infants depends on various factors, including the infant's age, weight, and medical condition.
- According to a study published in 2021 2, preterm infants (>28 weeks) can achieve full enteral feeding sooner with NG tubes than with OG tubes.
- The same study found that the incidence of aspiration and feeding tube displacement was significantly higher in the OG tube group compared to the NG tube group.
- Another study published in 1993 3 determined the minimal insertion lengths for appropriate placement of OG tubes in very low birth weight infants (< 1500 gm), but did not provide a specific age or weight range for NG tube usage.
Age and Weight Considerations
- A study published in 2021 2 included preterm infants with a mean gestational age of 33.27 ± 1.08 weeks and a mean birth weight of 1753.3 ± 414.51 grams in the OG tube group, and 33.32 ± 1.57 weeks and 1859.6 ± 307.05 grams in the NG tube group.
- However, the study did not provide a specific age or weight range for NG tube usage, and instead focused on the comparison between OG and NG tubes in preterm infants.
- There is no clear evidence to suggest a specific age or weight range for NG tube usage in infants, and the decision to use an NG tube should be made on a case-by-case basis, taking into account the individual infant's medical condition and needs.
Placement and Verification Methods
- A study published in 2014 4 reviewed the reliability and safety of non-radiologic methods for verifying NG tube placement, including measurement of tube length, auscultation, and pH testing.
- Another study published in 2021 5 highlighted the importance of verifying NG tube placement using multiple bedside tests, including pH testing, CO2 detection, and point-of-care ultrasound, to reduce the risk of complications.
- However, these studies did not provide specific guidance on the age or weight range for NG tube usage in infants.