Abstract
Background:
Preterm neonates commonly require nasogastric tubes (NGT), which cause a significant increase in airway resistance likely increasing the number of clinically significant events (CSE). Head position also effects nasal airflow. The purpose of this study was to identify the effect of NGT placement and head position on CSE in preterm neonates.
Methods:
Prospective observational study of preterm infants off all respiratory support requiring an NGT and having CSE. Caregivers recorded dependent variables NGT position (upper or lower nostril or midline), and body position (prone, supine, side lying) and the independent variable, number of CSE. Statistics were 2-sample z-test for percentages. IRB approval was obtained.
Results:
27 neonates were enrolled in the study. Birth weight was 1463.6+419. 7 grams. Gestational age was 30.4+2.7 weeks. Weight when entering the study was 1651.7+324.7 grams and age was 21.1+17.7 d. There were 39.5+31.5 CSE recorded per neonate. 38% of the total number of CSE occurred when the NG tube was in the upper nostril, 34% in the lower nostril, and 28% when head midline (P=0.006 upper nostril versus head midline). 12.7% of total CSE occurred when the neonates were prone, 35.9% when supine, and 51.4% when side lying. There were more CSE when positioned side lying compared to both prone (P<0.0001) and supine (P<0.0001) and more CSE when positioned supine versus prone (P<0.0001). When both prone and side lying there were less CSE with the NGT midline compared to both in the upper (P=0.04 prone and P<0.0001 side lying) and lower (P=0.001 prone and P=0.004 side lying) nostril. When supine, there were more CSE with the NGT midline compared to both in the upper (P<0.0001) and lower (P<0.0001) nostrils.
Conclusions:
Least CSE occurred with the neonate prone or the NGT midline. Most CSE occurred when side lying or with the NGT in the upper nostril.
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