Clinical Research: Indicators of Feeding-Tube Placement in Neonates

Abstract

This article presents a literature review of methods used to determine feeding-tube placement in neonates and describes a small clinical study in which several methods that were tested in adults were also evaluated in neonates. According to the literature review, clinicians usually determine feeding-tube placement in neonates by one or more of the following methods: auscultating for insufflated air, testing the pH of feeding-tube aspirates, or radiography. The study reported in this article consisted of describing the pH as well as the enzyme and bilirubin content of 90 feeding-tube aspirates from 39 acutely ill neonates. Eighty-eight of the aspirates were from nasogastric or orogastric tubes and 2 were from nasointestinal tubes. Three-fourths of the infants were receiving ranitidine, about half had fasted for 4 or more hours, and about half were receiving continuous feedings. As expected, the mean gastric pH was substantially lower than the mean intestinal pH (4.32 vs 7.80, respectively). The neonates' mean fasting gastric pepsin concentration (76.1 μ/ml) was much lower than that of adults. The two specimens of intestinal fluid contained substantial quantities of trypsin and bilirubin, similar to levels reported in adults. Because of the limited sample of intestinal specimens, it was not possible to determine the ability of pH and concentrations of enzymes and bilirubin in the aspirates to distinguish between feeding-tube location in the stomach and small intestine in neonates.