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Am J Perinatol 2021; 38(14): 1526-1532
DOI: 10.1055/s-0040-1713865
Original Article

Nasogastric versus Orogastric Bolus Tube Feeding in Preterm Infants: Pilot Randomized Clinical Trial

Ahmed Tawfik Badran
1   Department of Pediatrics, SUNY Downstate Health Sciences University, Brooklyn, New York
,
Menna Hashish
2   Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt
,
Alaa Ali
3   Department of Pediatrics, National Research Center, Cairo, Egypt
,
Mohamed Shokeir
4   Department of Pediatrics, Mansoura University Children's Hospital, Mansoura, Egypt
,
Abd Shabaan
2   Neonatal Intensive Care Unit, Mansoura University Children's Hospital, Mansoura, Egypt
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Erratum: Nasogastric versus Orogastric Bolus Tube Feeding in Preterm Infants: Pilot Randomized Clinical TrialAm J Perinatol 2021; 38(14): e2-e2
DOI: 10.1055/s-0040-1714720

Abstract

Objective According to the most recent metanalysis, the best way to establish safe enteral feeding in preterm babies using nasogastric or orogastric tubes is still not well understood. This study aimed to determine the effects of bolus nasal tubes versus bolus orogastric tubes on the time required to reach full enteral feeding in preterm infants, as well as to compare the incidence rates of adverse events including nonintentional removal or displacement of the feeding tube, aspiration pneumonia/pneumonitis, apnea, necrotizing enterocolitis, gastric residual, and growth parameters between the studied cohort of preterm infants.

Study Design We conducted an unblinded pilot randomized clinical trial on hemodynamically stable preterm infants (>28 weeks) recruited from level 2 neonatal intensive care unit at Mansoura University Children's Hospital from June 2015 to May 2017.

Results Our study included 98 stable preterm infants with mean gestational age (orogastric group: 33.27 ± 1.08, nasogastric group: 33.32 ± 1.57) and mean birthweight (orogastric group: 1,753.3 ± 414.51, nasogastric group: 1,859.6 ± 307.05). Preterm infants who were fed via bolus nasogastric tube achieved full enteral feeding in a significantly shorter duration compared with the infants fed via bolus orogastric tube. The incidence rates of aspiration and feeding tube displacement were significantly higher in the bolus orogastric tube group compared with the bolus nasogastric tube group. There was no difference in the incidence rates of apnea, necrotizing enterocolitis, bradycardia, oxygen desaturation, and gastric residual in both groups.

Conclusion Preterm infants without any respiratory support receiving bolus nasogastric tube feeding achieved full enteral feeding significantly sooner than those receiving bolus orogastric tube feeding. Additionally, bolus nasogastric tube feeding had a lower incidence of aspiration, tube displacement, and the infants regained birthweight more quickly than those receiving orogastric tube feeding.

Key Points

  • Preterm babies achieve full entral feeds sooner by nasogastric tubes than orogastric tubes.

  • Incidence of nasogastric tube displacement and aspiration is less than orogastric tube.

  • Infants on nasogastric tubes feeding regain birth weight quicker than those fed by orogastric tubes.

Keywords

preterm baby - enteral feeding - nasogastric tubes - orogastric tubes - growth - adverse effects


Publication History

Received: 24 March 2020

Accepted: 27 May 2020

Article published online:
03 July 2020

© 2020. Thieme. All rights reserved.

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  • References

  • 1 Watson J, McGuire W. Nasal versus oral route for placing feeding tubes in preterm or low birth weight infants. Cochrane Database Syst Rev 2013; CD003952 (02) CD003952
    PubMedGoogle Scholar
  • 2 Kültürsay N, Bilgen H, Türkyılmaz C. Turkish Neonatal Society guideline on enteral feeding of the preterm infant. Turk Pediatri Ars 2018; 53 (01, Suppl 1): S109-S118
    PubMedGoogle Scholar
  • 3 Dutta S, Singh B, Chessell L. et al. Guidelines for feeding very low birth weight infants. Nutrients 2015; 7 (01) 423-442
    CrossrefPubMedGoogle Scholar
  • 4 Shiao SY, DiFiore TE. A survey of gastric tube practices in level II and level III nurseries. Issues Compr Pediatr Nurs 1996; 19 (03) 209-220
    CrossrefPubMedGoogle Scholar
  • 5 Birnbaum R, Limperopoulos C. Nonoral feeding practices for infants in the neonatal intensive care unit. Adv Neonatal Care 2009; 9 (04) 180-184
    CrossrefPubMedGoogle Scholar
  • 6 Gregory KE, Connolly TC. Enteral feeding practices in the NICU: results from a 2009 Neonatal Enteral Feeding Survey. Adv Neonatal Care 2012; 12 (01) 46-55
    CrossrefPubMedGoogle Scholar
  • 7 Greenspan JS, Wolfson MR, Holt WJ, Shaffer TH. Neonatal gastric intubation: differential respiratory effects between nasogastric and orogastric tubes. Pediatr Pulmonol 1990; 8 (04) 254-258
    CrossrefPubMedGoogle Scholar
  • 8 Stocks J. Effect of nasogastric tubes on nasal resistance during infancy. Arch Dis Child 1980; 55 (01) 17-21
    CrossrefPubMedGoogle Scholar
  • 9 Purcell M. Response in the newborn to raised upper airway resistance. Arch Dis Child 1976; 51 (08) 602-607
    CrossrefPubMedGoogle Scholar
  • 10 Tonkin SL, Partridge J, Beach D, Whiteney S. The pharyngeal effect of partial nasal obstruction. Pediatrics 1979; 63 (02) 261-271
    CrossrefPubMedGoogle Scholar
  • 11 Hawes J, McEwan P, McGuire W. Nasal versus oral route for placing feeding tubes in preterm or low birth weight infants. Cochrane Database Syst Rev 2004; (03) CD003952
    PubMedGoogle Scholar
  • 12 Ellett MLC, Maahs J, Forsee S. Prevalence of feeding tube placement errors & associated risk factors in children. MCN Am J Matern Child Nurs 1998; 23 (05) 234-239
    CrossrefPubMedGoogle Scholar
  • 13 Haxhija EQ, Rosegger H, Prechtl HF. Vagal response to feeding tube insertion in preterm infants: has the key been found?. Early Hum Dev 1995; 41 (01) 15-25
    CrossrefPubMedGoogle Scholar
  • 14 Arens R, Reichman B. Grooved palate associated with prolonged use of orogastric feeding tubes in premature infants. J Oral Maxillofac Surg 1992; 50 (01) 64-65
    CrossrefPubMedGoogle Scholar
  • 15 Bohnhorst B, Cech K, Peter C, Doerdelmann M. Oral versus nasal route for placing feeding tubes: no effect on hypoxemia and bradycardia in infants with apnea of prematurity. Neonatology 2010; 98 (02) 143-149
    CrossrefPubMedGoogle Scholar
  • 16 Dsilna A, Christensson K, Alfredsson L, Lagercrantz H, Blennow M. Continuous feeding promotes gastrointestinal tolerance and growth in very low birth weight infants. J Pediatr 2005; 147 (01) 43-49
    CrossrefPubMedGoogle Scholar
  • 17 van Someren V, Linnett SJ, Stothers JK, Sullivan PG. An investigation into the benefits of resiting nasoenteric feeding tubes. Pediatrics 1984; 74 (03) 379-383
    CrossrefPubMedGoogle Scholar
  • 18 Kendig & Chernick's. Disorders of the Respiratory Tract in Children Book. 8th Edition.. Netherlands, Amsterdam: Elsevier; 2012
    Google Scholar
  • 19 Son YG, Shin J, Ryu HG. Pneumonitis and pneumonia after aspiration. J Dent Anesth Pain Med 2017; 17 (01) 1-12
    CrossrefPubMedGoogle Scholar
  • 20 Neu J, Walker WA. Necrotizing enterocolitis. N Engl J Med 2011; 364 (03) 255-264
    CrossrefPubMedGoogle Scholar
  • 21 Li YF, Lin HC, Torrazza RM, Parker L, Talaga E, Neu J. Gastric residual evaluation in preterm neonates: a useful monitoring technique or a hindrance?. Pediatr Neonatol 2014; 55 (05) 335-340
    CrossrefPubMedGoogle Scholar
  • 22 de Waard M, Li Y, Zhu Y. et al. Time to full enteral feeding for very low-birth-weight infants varies markedly among hospitals worldwide but may not be associated with incidence of necrotizing enterocolitis: The NEOMUNE-NeoNutriNet Cohort Study. JPEN J Parenter Enteral Nutr 2019; 43 (05) 658-667
    CrossrefPubMedGoogle Scholar
  • 23 Kamalakar Rao N, Udaykanth S. Nasal versus oral route for placing feeding tubes in preterm or low birth weight infants. MRIMS J Health Sci 2015; 3 (03) 190-195
    CrossrefPubMedGoogle Scholar
  • 24 Dollberg S, Kuint J, Mazkereth R, Mimouni FB. Feeding tolerance in preterm infants: randomized trial of bolus and continuous feeding. J Am Coll Nutr 2000; 19 (06) 797-800
    CrossrefPubMedGoogle Scholar
  • 25 Schanler RJ, Shulman RJ, Lau C. Feeding strategies for premature infants: beneficial outcomes of feeding fortified human milk versus preterm formula. Pediatrics 1999; 103 (6 Pt 1): 1150-1157
    CrossrefPubMedGoogle Scholar
  • 26 Akintorin SM, Kamat M, Pildes RS. et al. A prospective randomized trial of feeding methods in very low birth weight infants. Pediatrics 1997; 100 (04) E4
    CrossrefPubMedGoogle Scholar
  • 27 Silvestre MAA, Morbach CA, Brans YW, Shankaran S. A prospective randomized trial comparing continuous versus intermittent feeding methods in very low birth weight neonates. J Pediatr 1996; 128 (06) 748-752
    CrossrefPubMedGoogle Scholar
  • 28 Premji SS, Chessell L. Continuous nasogastric milk feeding versus intermittent bolus milk feeding for premature infants less than 1500 grams. Cochrane Database Syst Rev 2011; 2011 (11) CD001819
    PubMedGoogle Scholar
  • 29 Sullivan PGHH, Haringman H. An intra-oral appliance to stabilise orogastric tube in premature infants. Lancet 1981; 1 (8217): 416-417
    CrossrefPubMedGoogle Scholar
  • 30 Blencowe H, Cousens S, Oestergaard MZ. et al. National, regional, and worldwide estimates of preterm birth rates in the year 2010 with time trends since 1990 for selected countries: a systematic analysis and implications. Lancet 2012; 379 (9832): 2162-2172
    CrossrefPubMedGoogle Scholar
  • 31 Symington A, Ballantyne M, Pinelli J, Stevens B. Indwelling versus intermittent feeding tubes in premature neonates. J Obstet Gynecol Neonatal Nurs 1995; 24 (04) 321-326
    CrossrefPubMedGoogle Scholar
  • 32 Therapie der idiopathischen Apnoe-Anfälle bei Frühgeborenen. Accessed June 16, 2003 at: http://www.uni-duesseldorf.de/awmf/ll/024–013.htm
    Google Scholar