Nasal versus oral route for placing feeding tubes in preterm or low birth weight infants

Background: Incorrect placement, or subsequent displacement, of feeding tubes into the lower oesophagus or into the lung can lead to aspiration, respiratory compromise, and increased energy expenditure. These effects are potentially detrimental to growth and development. Enteral feeding tubes passed via the nose may be easier to secure to the face than orally placed tubes. In children, orally placed enteral tubes are more frequently malpositioned compared to nasally placed tubes.6 Furthermore, orally placed tubes may be easier to displace as they can loop inside the mouth. Objective: To determine the effect of nasal compared with oral placement of enteral feeding tubes on feeding, growth and the incidence of adverse consequences in preterm or low birth weight infants. Methods: Preterm neonates admitted to NICU during the study period were stabilized initially (temperature, perfusion, respiratory status, blood sugars) and feeds were started. Infants were randomised to receive either nasogastric or orogastric feeding. Feeds were given over 10 - 20 minutes by gravity drainage every two or three hours. Results: Nasogastric tube feeding appears to be superior to orogastric tube feeding with less frequency of tube displacement. There is no difference among 2 groups in time to regain birth weight, time to full feeds, and frequency of adverse events. Nasogastric tube feeding group had lesser duration of hospital stay compared to the orogastric tube group, and orogastric tube feeding group reached to oral feeds quickly compared to nasogastric tube feeding group, however, this was not statistically significant. Further good quality randomised controlled trials with a larger population would probably be required to know the significance of this outcome. Conclusion: This study provides sufficient evidence to practice nasogastric tube feeding over orogastric tube feeding in preterm or low birth weight infants