Optimizing radiographic control of gastric feeding tubes in neonates

Objectives: This study should examine, whether injection of air via gastric feeding tube improves stomach visibility on radiographs and thereby improves definition of gastric feeding tube positions in neonates. The reproducibility of defining tube positions on radiographs using this method and the safety of this method should be determined. Methods: In neonates undergoing radiography we injected 5–10ml of air via lying gastric feeding tube prior to taking the radiograph. In an observer-interventional study design the usefulness of this procedure was analysed by comparing radiographs taken with and without this intervention. Prevalence of correct and incorrect gastric tube positions, as well as possible interacting factors were analysed. Results: In 8 of 153 radiographs (5%) with air filling no classification of exact gastric tube position was possible, compared to 78 of 381 radiographs (21%) taken without this intervention. This leads to a significant reduction of indefinable gastric tube positions (p-value <0.001). Inter- and intra-rater agreements with the intervention were both 96%. Furthermore, low gastric feeding tube position was associated with a higher amount of bloody gastric aspirates.

Conclusion: This new standardised procedure improves the visibility of the gas bubble of the stomach on radiographs and thereby significantly improves the definition of exact gastric feeding tube position in neonates. This method shows good reproducibility, is safe and easy to perform. It helps to achieve optimal assessment of gastric feeding tube positions and therefore may prevent harm caused by malposition of the feeding tube.