I woulg like to know the opinion and experience of others in method of tube feeding in nicu.

1 . Tube feeding oro-gastric, tube is removed every time after feed.

2. onasogastric feeds, tube remains ther.

3. orogastiric, tube is passed from mouth ,is fixed on face and intermittent feeds are givem by nursing staff. Ihave seen some units are very comfortable with this method ,but fear is of displacing the tube with some activity.

thanks

We only use nasogastric tubes. They are secured the following way:

a small rectangular hydrocolloid tape is attached to the chin, and then the tube is taped on top of that.

We practise contineous feeding ("milk drip") on the tiniest infants (typically those below 28 weeks) and intermittent bolus feeding on more mature infants.

We use orogastric tubes.

Inserted once a day after the morning care.

Prior to each feed is checked visually for correct length of insertion and by auscultation.

We use bolus feed in all babies except those with persistent feeding intolerance in whom we use continuous feeding. ( We do not use continuous feeding routinely as there is a very small risk of error with relation to connection of the milk and intralipid tubings to IV canula and orogastric tube respectively instead of the other way around. To read more on this error see ---- Ryan CA, Mohammad I, Murphy B. Normal Neurologic and Developmental Outcome After an Accidental Intravenous Infusion of Expressed Breast Milk in a Neonate. Pediatrics. 2006 Jan 1;117(1):236-238.

LINK )

We do OG and NG tubes, we prefer NG but if the baby is on nasal cpap or cannula then OG it is. We have long term tubes that can be left in for 7 days. We confirm by aspiration and auscultation. It's secured with a small piece of tegaderm on the face. We do gravity-fed bolus feeds every 3 hours on our larger kids and smaller feeds every 2 hours on our 30 wk and less kids. It's not perfect, our fiesty babies do pull their tubes out on occassion, but it works for us.

we use mainly NGT occasionally we use OGT. we do change it routinly Q72hrs unless there is a reason to be change earlier .

As we all know neonates are Obligate Nasal breather we mostly use Orogastric tube feeding.

We start Trophic feeding ASAP. We start advancing volume arround 5th day of trophic feed . Mostly we give bolus (as it seems more physiological) Occaisonally we do use CNG/COG feeding. Tubes stays after feed as its painful procedure to perform before each feed ( In my opinion its not advisable to do so at all).

We use a silicone indwelling tube that the manufacturer states can be left for 30 days. That seemed too long so we leave in a max of 14 days. We secure to the cheek using a protective barrier under the tape or a breatheable membrane type dressing. If we a pumping feedings over time we use an enteral only type connecting tubing to avoid the mix up Jack (above) referenced. We also mostly do bolus feedings. We verify placement by pulling back for aspirate or listening for an air bubble over the stomach prior to each feeding. The infants sometimes do pull the tubes out but this is still less traumatic than the constant placement for each feeding.

I think that NGT is very safe and therefore used for feeding .

We use intermittent bolus feeding , ofcourse following the weight of the baby every day

Thank you

dr Hasan Nimer

Aleeman Hospital

Jordan

We use Orogastric tubes that will be changed once a dsay. A verification of the placement must be done before every enteral feeding. for fixation we use the same materiel used to the tracheal tube.

wich kind of strategy do you use for preterm ELBW nutrition? do you prefer bolus-feeding or continuous feeding? and is better to continue with parenteral nutrition until 2 wks of life to achieve a good intake or do you prefer to switch to enteral feeding as soon is possible?

I ask that because we tent to achive a good enteral intake but often we find "intestinal"intolerance and so we have to stop and to restart again afeter some hours. there is any strategy to improve intestinal transit and tolerance?

wich kind of strategy do you use for preterm ELBW nutrition?...

We try to start minimal enteral feeding asap, usually during the first days of life. If we go for bolus feeding we typically start with 0.5-1 ml every 3 hours in the smallest infants, and keep this small volume until the baby gets more stable and tolerate larger volumes.

After some research done in our department (see link below), we typically start with continuous feeding now.

http://www.ncbi.nlm.nih.gov/pubmed/16027693

And a word of caution: we have a lot of respect for feed residuals especially in the most immature infants. But minimal feeding is usually tolerated well.

thank you very much!!

Merry Xmas to you and to all the staff!!

Concetta