Background and aims Nasogastric tube (NGT) feeding is used extensively in neonatal units. Hundreds of feeding tubes are inserted daily without incident. However, there is a risk of the tube being inserted into the respiratory tract or becoming misplaced out of the stomach after the initial insertion.¹ A review of cases that were managed for complications of misplaced NGT at a regional tertiary neonatal unit was carried out to understand the clinical presentation, management and outcome.

Methods Infants diagnosed with oesophageal or stomach perforation between 2010 and 2016 were identified on the neonatal unit database. 17 cases of misplaced NGT were identified, 2 cases of suspected right bronchial NGT placement were excluded.

Results 6 infants were managed for oesophageal perforations and 9 were managed for gastric perforation. All cases of oesophageal perforation occurred in preterm infants weighing less than 1000g and were diagnosed on CXR following intubation or a failed pH indicator test. Oesophageal perforations were managed conservatively with a 7–21 day period of no feeds and antibiotic cover. Video fluoroscopy was used to reinsert a new nasogastric tube as well as excluding leaks or strictures prior to feeding.

9 infants who presented with acute abdominal distension and pneumo-peritoneum were found to have stomach perforation at laparotomy. The operating surgeons suspected the gastric perforations to have been caused by an NGT. These cases were initially suspected of perforated necrotising enterocolitis (NEC), but this was excluded at laparotomy. No deaths occurred from complications of misplaced nasogastric tubes in this cohort.

Conclusion Low birth weight infants are at particular risk of perforation from nasogastric tube. It is important to recognise misplaced nasogastric tube before feeding to prevent serious complications. Oesophageal perforations can be managed conservatively without complications. If there is any doubt on the position of and NGT get an X-ray before feeding..

References

1. Reducing the harm caused by misplaced naso and orogastric feeding tubes in babies under the care of neonatal units - NPSA