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A Randomized Controlled Trial Comparing Two Techniques of Enteral Feeding Tube Placement in Critically Ill Newborn
Norma Mejias Quinteiro1, Elenice Valentim Carmona, Klaus Schumacher
1Author Affiliations: School of Medical Sciences and Women's Hospital, State University of Campinas (UNICAMP) Campinas, São Paulo, Brazil (Dr Mejias Quinteiro); School of Nursing, State University of Campinas (UNICAMP) Campinas, São Paulo, Brazil (Dr Carmona); Women's Hospital, State University of Campinas (UNICAMP) Campinas, São Paulo, Brazil (Dr Schumacher); Departament of Pediatrics and School of Medical Sciences, State University of Campinas (UNICAMP) Campinas, São Paulo, Brazil(Dr Caldas).
Insights
Gastric air insufflation did not improve transpyloric tube placement success in infants. This method did not increase correct placement rates or reduce complications in neonatal feeding.
Area of Science:
- Neonatal medicine
- Pediatric gastroenterology
- Medical device technology
Background:
- Feeding intolerance is common in infants, often requiring transpyloric tube feeding for enteral nutrition.
- Transpyloric tube placement success rates can vary, impacting nutritional delivery.
Purpose of the Study:
- To compare the efficacy of gastric air insufflation in aiding transpyloric tube placement in infants.
- To assess potential complications associated with postpyloric feeding.
Main Methods:
- A randomized controlled trial in a neonatal unit compared gastric air insufflation (intervention group) versus standard methods (control group).
- Correct tube positioning was radiographically confirmed as the distal end reaching the duodenum (3rd/4th portion).
Main Results:
- The success rate of correct transpyloric tube placement was identical in both groups (45.4%).
- No significant differences were observed in birth weight, gestational age, or age at procedure between groups.
- Complications, including necrotizing enterocolitis and jejunal perforation, occurred in two infants but were unrelated to the tube placement procedure.
Conclusions:
- Gastric air insufflation does not enhance the success rate of transpyloric tube placement in infants.
- The procedure-related complication rate was not affected by the use of gastric air insufflation.
- Further research may explore alternative methods to improve transpyloric tube placement accuracy and safety.
Background:
Feeding intolerance can hinder enteral nutrition in infants, often necessitating transpyloric tube feeding. However, the success of transpyloric tube placement varies.
Purpose:
To compare the rate of correct transpyloric tube placement in infants with and without gastric air insufflation, and to assess complications associated with postpyloric feeding.
Methods:
A randomized controlled trial was conducted in a tertiary neonatal unit of a public teaching hospital. The estimated sample size included 11 participants in the intervention group (IG) and 11 in the control group (CG). In the IG, transpyloric tube insertion was aided by gastric air insufflation. Correct positioning was defined as the distal end of the tube reaching the third or fourth portion of the duodenum, as confirmed by radiography.
Results:
The success rate of correct tube placement was the same in both groups (45.4% vs 45.4%, P = 1.000). Two infants experienced complications (necrotizing enterocolitis and jejunal perforation), neither of which were related to the procedure.
Implications For Practice And Research:
There were no significant differences between the IG and CG in terms of birth weight (1030 g vs 985 g, P = .895), gestational age (27 weeks vs 28 weeks, P = .973), or age at the time of the procedure (28 days vs 39 days, P = .224). The rate of jejunal tube placement was also statistically similar (27.7% vs 9.1%, P = .269). Gastric air insufflation did not increase the rate of successful transpyloric tube placement. Observed complications were not attributable to the procedure.
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