Pitfalls of gastric intubation in premature infants

Sudhakaran, Nada; Kirby, CP

doi:10.1046/j.1440-1754.2001.00610.x

Cited by 8 publications

(7 citation statements)

References 8 publications

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“…Incorrect OGt placements remain a valid concern because of potential tracheobronchial aspiration as well as pharyngeal or esophageal perforation [7][8][9][10][11].…”

Section: Discussionmentioning

confidence: 99%

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An improved method to determine orogastric tube insertion length in extremely low birth weight infants

Cordero

Nankervis

Coley

et al. 2011

Journal of Neonatal-Perinatal Medicine

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Background: Traditionally, orogastric tube (OGt) insertion length is determined by nose-earlobe-xyphoid (NEX) measurement. Minimum insertion lengths have been proposed for prematures but not for extremely low birth weight (ELBW) infants.Objective: To determine minimum OGt insertion length for intragastric placement in ELBW infants using NEX measurements alone and NEX measurements in conjunction with a novel regression formula.Design/Methods: Retrospective phase (83 pts): Correct intragastric placements were identified and a regression formula for predicting insertion length was created. Prospective phase (50 pts): Nurses were instructed to use NEX measurements if they coincided within 1 cm with estimates from the regression formula (birth weight g × 0.004 + 9.44 = cm insertion length). In cases of discrepancy, measurements calculated by the formula were used.Results: Using NEX method alone, the first OGt placements were in the esophagus (6%), straight in the stomach (6%), reversed in the stomach (4%), in the duodenum (1%) and "correctly" placed diagonal in the stomach (83%). Using NEX measurement and the regression formula, OGt placements were diagonal in the stomach (96%), or straight in the stomach (4%), with none in the esophagus, reversed in the stomach or in the duodenum. The difference in correct placements by the two methods was significant.Conclusions: NEX measurements in conjunction with a minimum insertion length estimated from a formula should decrease the number of malpositioned OGt in ELBW infants.

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“…Incorrect OGt placements remain a valid concern because of potential tracheobronchial aspiration as well as pharyngeal or esophageal perforation [7][8][9][10][11].…”

Section: Discussionmentioning

confidence: 99%

“…Placing an OGt incorrectly could have significant clinical consequences such as tracheobronchial aspiration or pharyngeal, gastric or esophageal perforation [7][8][9][10][11].…”

Section: Introductionmentioning

confidence: 99%

An improved method to determine orogastric tube insertion length in extremely low birth weight infants

Cordero

Nankervis

Coley

et al. 2011

Journal of Neonatal-Perinatal Medicine

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“…In most neonatal cases of esophageal perforation, the perforation is secondary to passage of endotracheal or nasogastric feeding tubes and usually occurs in the upper esophagus. [1][2][3][4][5][6][7] Although infants with esophageal perforation may exhibit only subtle signs, such as increased oral secretions and poor feeding, they may also experience respiratory distress and high fever. 1,8 On development of esophageal perforation, our patient showed rapid progression of respiratory distress followed by laboratory findings that suggested the presence of infection.…”

Section: Discussionmentioning

confidence: 99%

“…E sophageal perforation, a complication in neonates with nasogastic or orogastric feeding tubes, can cause pneumomediastinum, pneumo-thorax, and hydropneumothorax. [1][2][3][4][5][6] The diagnosis of esophageal perforation is usually made on plain radiography and esophagography. In this report, we describe the case of an infant of extremely low birth weight in whom esophageal perforation caused by a malpositioned feeding tube was diagnosed on sonography.…”

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confidence: 99%

Sonographic detection of a malpositioned feeding tube causing esophageal perforation in a neonate

Maruyama

Shiojima

Koizumi

2003

J of Clinical Ultrasound

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We report a case of esophageal perforation caused by a malpositioned feeding tube in a neonate of extremely low birth weight, 632 g. The infant had respiratory distress, which increased rapidly when he was 6 days old. Radiography revealed right-sided hydrothorax that had not been evident a day earlier but no sign of a perforated esophagus. We performed sonography, which revealed fluid in the right pleural cavity and extra-esophageal placement of the feeding tube. Analysis of a fluid specimen obtained on thoracocentesis indicated that the fluid was feeding formula. The feeding tube's misplacement was confirmed sonographically by injecting a small amount of sterile distilled water into the tube and visualizing its entry into the pleural cavity. The feeding tube was removed, and antimicrobial agents were administered. When the infant was 15 days old, feeding resumed through another tube, the placement of which was verified radiographically. The infant was discharged when he was 118 days old with no severe complications, although he had mild chronic lung disease. Because radiography did not reveal the tube's misplacement in this case, we believe that the use of sonography can contribute to an early diagnosis of esophageal perforation in such cases.

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“…Commonest among iatrogenic causes of esophageal perforation are balloon dilatation of the strictures secondary to repair of the esophageal atresia and intubation and instrumentation during aggressive resuscitative measures, practised in modern day intensive care units on premature and low-birthweight babies. 1 Non-iatrogenic infl icted injury to the esophagus such as in child abuse is very rare. Such cases are commonly due to foreign body insertion.…”

mentioning

confidence: 99%