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Procedures for a Transpyloric Feeding Tube Inserted Into Newborns and Infants: A Systematic Review
Norma Mejias Quinteiro1, Josilene Fioravanti Dos Santos, Jamil Pedro de Siqueira Caldas
1University of Alabama at Birmingham, School of Nursing, Birmingham, Alabama.School of Medical Sciences and Women's Hospital (Ms Quinteiro), Women's Hospital (Ms Fioravanti dos Santos), Department of Pediatrics, School of Medical Sciences (Dr de Siqueira Caldas), School of Nursing (Dr Carmona), State University of Campinas (UNICAMP), Campinas, São Paulo, Brazil.
Insights
Transpyloric feeding tube insertion in critically ill infants has variable success rates (70-100%). Establishing standardized protocols and further research into techniques like gastric air insufflation are recommended for optimal infant nutrition.
Area of Science:
- Neonatal Medicine
- Pediatric Gastroenterology
- Critical Care Pediatrics
Background:
- Enteral feeding via transpyloric tube is crucial for critically ill infants when gastric feeding fails.
- Significant variability exists in current transpyloric tube insertion techniques.
- Optimizing tube placement is essential for effective nutritional support and reducing complications.
Approach:
- Systematic review of experimental and nonexperimental studies on transpyloric tube insertion in newborns and infants.
- Searched nine databases without date or language restrictions.
- Analyzed six observational descriptive prospective studies following PRISMA guidelines.
Key Points:
- Success rates for transpyloric tube placement range from 70% to 100%.
- Wide variability observed in tube types, measurement methods, and insertion techniques.
- Commonly used techniques for proper positioning include glabella-calcaneal measurements, gastric air insufflation, and right lateral decubitus.
Conclusions:
- Neonatal units should establish standardized transpyloric catheter insertion protocols based on evidence.
- Further randomized controlled studies are needed to evaluate techniques like gastric air insufflation and adjuvant measures.
- Research should focus on closing knowledge gaps regarding the correct positioning of transpyloric tubing in infants.
Background:
Enteral feeding by a transpyloric tube in critically ill infants is indicated when there is a failure in gastric feeding. However, there is a wide variability regarding the insertion technique.
Purpose:
To perform a systematic review of the methods for inserting a transpyloric feeding tube in newborns and infants.
Data Sources:
Nine databases, without date or language restrictions, accessed in September 2021.
Study Selection:
A systematic review of experimental and nonexperimental studies, according to the "Patient/problem; Intervention; Comparison; Outcome" strategy and the "Preferred Reporting Items for Systematic Reviews and Meta-Analyses" guidelines. The clinical question was about the measurement and insertion techniques, as well as the success rates of properly placing a transpyloric tube in newborns and infants.
Data Extraction:
Two authors (N.M.Q. and J.F.S.) analyzed 6 observational descriptive prospective studies, all of them published in peer-reviewed indexed medical journals and one in the official journal of the National Association of Neonatal Nurses.
Results:
The success rate varied between 70% and 100%. There was an important variability in the type of tube, measurement method, and insertion techniques. It was found that the most common strategies to achieve proper positioning were glabella-calcaneal measurements, gastric air insufflation, and right lateral decubitus.
Implications For Practice:
A transpyloric catheter insertion protocol needs to be established in each neonatal unit, according to the literature findings.
Implications For Research:
Randomized controlled studies that evaluate the gastric air insufflation technique and other adjuvant measures could elucidate the knowledge gap concerning the correct positioning of transpyloric tubing in newborns and infants.
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