Randomized Clinical Trial Comparing Two Methods of Measuring Insertion Length of Nasogastric Tubes in Newborns

Abstract

IntroductionThe selection of a method for measuring the insertion length of nasogastric tubes in newborns is an important factor in establishing the safe use of this device.ObjectiveThe objective was to verify whether there is a difference in the proportion of correctly placed nasogastric tubes when using the nose, earlobe, mid‐umbilicus (NEMU) method and the weight‐based equation for measuring the insertion length.MethodsThis study is a randomized, controlled, blinded study comparing 2 methods of nasogastric insertion at a neonatal unit, with intensive and intermediate care, on 162 randomized individuals. Radiological assessment and pH test were conducted to verify tube placement. Data were collected on sex, birth weight, gestational age, and days of life. A log‐binomial model was used to verify whether there were placement differences between investigated methods.ResultsOf the patients, 56.1% were male, who had a mean birth weight of 1886.8 g and gestational age of 32.9 weeks and were 10.8 days old. Radiological images demonstrated that tubes were properly placed in the gastric body in 67.5% of patients using the NEMU method and in 91.5% using the weight‐based equation: the weight‐based equation was superior to the NEMU method, with a prevalence ratio of 1.36 (95% CI, 1.15–1.44). There was no difference between the 2 methods, according to pH test (P‐value: .7179).ConclusionBased on radiographic confirmation, the weight‐based equation for measuring the insertion length of the nasogastric tube in newborns resulted in significantly more nasogastric tubes being placed in the correct intragastric location.

RETRACTED ARTICLE: The effect of early oral stimulation with breast milk on the feeding behavior of infants after congenital cardiac surgery

“…Due to increased caloric requirements and delayed oral motor skills associated with long-term tracheal intubation, infant patients might need to receive nasogastric tube feeding for a long time or require other nutritional methods, which might cause oral motor development delay, increase gastroesophageal reflux, etc. [23] Studies have shown that in infants who do not have difficulty swallowing, those who have undergone early postoperative oral stimulation recovery training had indwelling gastric tubes for 3 days less than those who have not received such training [24]. These conclusions are consistent with our findings, suggesting that our interventions were effective in postoperative recovery in infant patients with CHD.…”

Comparison of 3 Methods for Measuring Gastric Tube Length in Newborns

“…We found differences in the percentage of correctly positioned GTs depending upon whether correct placement was defined as within the gastric body only or within either the gastric body or greater curvature of the stomach. These findings are similar to other studies and while both locations represent correct positioning, placement within the gastric body may be preferable since the tube tip is less likely to press against the stomach wall potentially causing injury 3,4,17…”

“…These findings are similar to other studies and while both locations represent correct positioning, placement within the gastric body may be preferable since the tube tip is less likely to press against the stomach wall potentially causing injury. 3,4,17 In a study of 173 infants, which examined GT positioning only within the stomach, the ARHB method correctly determined insertion length in 78% of infants, which is lower than our findings of 88.7%. 5 However, they found the NEMU method had an accuracy rate of 90.9%, which is higher than our findings of 73.8%.…”

“…While results were not statistically significant, they may be clinically important because the NEMU method is currently considered standard care in most NICUs but may not be the most accurate method to determine insertion depth. Findings of our research are similar to those of a clinical trial conducted in a Brazilian NICU, which reported that, when compared with the NEMU method, a weight-based method was associated with a higher prevalence of correctly positioned GTs 17…”

“…The proportion of correctly positioned NGTs using the weight-based method was lower (81.5%) than those in a study by Dias et al17 (96%). This may be due to our higher rate of participant withdrawal due to no confirmatory radiograph and the inability to visualize the tube tip on radiograph.…”