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QUESTION 1: Should the passage of a nasogastric tube be universal to all babies born to mothers with polyhydramnios or targeted to those with additional findings on ultrasound?
  1. Natasha Ann Hart1,
  2. Nigel Osborne2,
  3. Helen Liversedge3
  1. 1 ST1 Paediatrics, Royal Devon and Exeter Hospital, Exeter, UK
  2. 2 Royal Devon and Exeter Hospital, Exeter, UK
  3. 3 Foetal Medicine, Royal Devon and Exeter Hospital, Exeter, UK
  1. Correspondence to Dr Natasha Ann Hart, ST1 Paediatrics, Bramble Ward, RD&E, Barrack Road, Exeter EX2 5DW, UK; Natasha.hart{at}nhs.net

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Scenario

You are requested by the midwifery team to attend the delivery of a term neonate as there is an antenatal history of polyhydramnios. Local guidelines state that a nasogastric tube (NGT) should be passed at birth and position confirmed by either pH testing or X-ray. At birth the baby appears clinically very well and the mother questions whether the procedure is still indicated.

Structured clinical question

In neonates born to mothers with polyhydramnios (patient), where antenatal scans are otherwise normal, is the passage of a NGT (intervention) indicated in all cases to exclude or confirm oesophageal atresia (outcome) or should it be targeted to those with other suggestive features on ultrasound scan?

Search

A PubMed search using the terms ‘polyhydramnios’ combined with ‘NG’ or ‘nasogastric’ and then ‘oesophageal atresia’ was undertaken. This gave 15 and 90 results, respectively, six of which were relevant to the clinical question; three other papers contained related data but focused on other …

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