Nasal versus oral route for placing feeding tubes in preterm or low birth weight infants

When preterm or low birth weight infants are too immature or unwell to suck feeds they can receive their milk through a feeding tube passed via either the nose or the mouth. Although tubes placed via the nose may be more stable and less prone to displace than tubes passed via the mouth, there is concern that nasal tubes will partially obstruct breathing. Only three small trials were found that compared these two options and these did not find convincing evidence to support routine use of one route rather than the other.

Authors' conclusions: 

There are insufficient data available to inform practice. A large randomised controlled trial would be required to determine if the use of naso- versus oro-enteric feeding tubes affects feeding, growth and development, and the incidence of adverse events in preterm or low birth weight infants.

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Background: 

Enteral feeding tubes for preterm or low birth weight infants may be placed via either the nose or mouth. Nasal placement may compromise respiration. However, orally placed tubes may be more prone to displacement, local irritation, and vagal stimulation.

Objectives: 

To determine the effect of nasal versus oral placement of enteral feeding tubes on feed tolerance, growth and development, and the incidence of adverse events in preterm or low birth weight infants.

Search strategy: 

We used the standard search strategy of the Cochrane Neonatal Review Group. This included searches of the Cochrane Central Register of Controlled Trials (The Cochrane Library, 2012, Issue 10), MEDLINE, EMBASE, and CINAHL (to September 2012), conference proceedings, and previous reviews.

Selection criteria: 

Randomised or quasi-randomised controlled trials that compared nasal versus oral placement of enteral feeding tubes in preterm or low birth weight infants.

Data collection and analysis: 

We extracted data using the standard methods of the Cochrane Neonatal Review Group with separate evaluation of trial quality and data extraction by two review authors. We synthesised data using a fixed-effect model and reported typical risk ratio (RR), risk difference (RD), and weighted mean difference (WMD).

Main results: 

Three studies fulfilled the review eligibility criteria. Two were parallel group trials (van Someren 1984; Dsilna 2005) and one was a cross-over trial (Bohnhorst 2010). The two parallel group randomised controlled trials enrolled 88 preterm infants. Only one trial reported data on the pre-specified primary outcomes for this review. This trial found no evidence of effect on the time taken to establish enteral feeding or the time taken to regain birth weight. However, the trial was underpowered to exclude modest effect sizes. We identified one randomised cross-over trial in which 35 very preterm infants participated. This study did not find any statistically significant effects on the incidence of apnoea, desaturation, and bradycardia during the study period.

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