Nonoral feeding practices for infants in the neonatal intensive care unit

The purpose of this study was to delineate current practice for the selection of nonoral feeding routes in level III neonatal intensive care units (NICUs) across Canada.

All level III Canadian NICUs (n = 28).

A written questionnaire was developed specifically for gathering data in the NICU about the current method of selection of feeding tubes.

We surveyed, by telephone, charge nurses at all level III NICUs to elucidate the current use of orogastric (OG) versus nasogastric (NG) route of tube for fullterm and preterm infants.

The results from this study indicate that 75% percent of NICUs in Canada primarily used NG tubes. Pediatric institutions were significantly more likely to use NG (>75% of the time) (P = .003). All of the centers (100%) using NG tubes used indwelling tubes. Only 18% of centers selected OG tubes primarily. Nonpediatric institutions were significantly more likely to use OG tubes (P = .001). Ten percent of NICUs reported using both NG and OG tubes equally. There was no difference indicated on selection of tube for preterm babies versus term babies. However, there was 100% agreement in the use of OG tubes in infants with structural anomalies of the nares or if the infants were on continuous positive airway pressure. Overall, decision regarding route of tube was made primarily according to physician preference and the natural history and experience within the NICU.

The results of this survey indicate that there are no clear clinical guidelines currently in place to determine route of feeding tubes in NICUs across Canada. Physician preference or history of the institution appears to be the most important variable in determining tube selection. Given the high prevalence of acute and chronic feeding difficulties among NICU survivors, the choice of route of tube should be guided by specific evidence-based criteria.