Prediction of nasogastric tube position in neonates admitted on a NICU; a comparison of two methods

Aim: 

To describe the number of appropriate orogastric/nasogastric (OG/NG) tube positions according to the age-related-height-based (ARHB) measurement compared with the used nose-ear-midway to the umbilicus method (NEMU) aiming for a decrease in tubes placed too deeply and no significance in tubes placed too highly. 

Methods: 

A prospective observational multi-centre study was conducted in three level III NICU's. All neonates requiring OG/NG tube were eligible. NEMU was used to determine the insertion length for OG/NG tubes. The position according to the ARHB was calculated using equations appropriate for the tube type. Radiological assessment was used to objectify the position of the tubes. 

Results: 

In 475 neonates the position of the OG/NG was radiologically visible. The percentage of correctly placed tubes using ARHB compared with NEMU was 44% vs 33.9% (p = 0.001). A decrease in the number of tubes inserted too deeply according to ARHB was observed 24.6% vs 49.1% with NEMU (p < 0.001). A significant increase in too highly placed tubes was observed with ARHB compared to NEMU 31.4% vs 17% (p < 0.001). 

Conclusion: 

The increase in too highly placed tubes, according to ARHB was undesirable. The method used for calculating the insertion length of the OG/NG tubes in neonates remains unclear.