Infant Tube Feeding

• Types of Tube Feeding

  • OROGASTRIC FEEDING (OG)
  • NASOGASTRIC FEEDING (NG)
• Orogastric Feeding: usually for pre-terms as they are predominantly nose breathers
• Intermittent Bolus -defined as delivering enteral nutrition multiple times, generally giving 15–30 min every 2–3 h by gravity or electric
• Intermittent Bolus: A most preferred because it releases GASTRIN that ↑ GI motility and ↑ GI development
• Continuous Drip Method - defined as delivering enteral nutrition with constant speed for 24 h via nutritional pump.
• Minimal Enteral Feeding - refer to small volume-feedings of formula or human milk (usually less than 24ml/kg/day)
• Benefits of Early Feedings (as early as 24-72 h of life)

  • No increase in the incidence of necrotizing enterocolitis (NEC)

  • Fewer days on total parenteral nutrition (TPN), thereby decreasing the incidence of cholestatic jaundice

  • Increased weight gain

  • Increased muscle maturation of the GUT as well as muscle growth

  • Increase in gut peristalsis

  • Increased gut hormone levels which can lead to improved feeding tolerance

  • Lower risk of osteopenia

  • A possible decrease in the total number of hospital days in

  the NICU
• If smaller baby = smaller lumen
• Feeding syringe > Food flows in > NG Tube
• Feeding tube: Fr 5 or 8
• Fr 5 commonly used for preterms
• > 1600: Fr 8
• Equipment:

  • Feeding tube: Fr 5 or 8
  • 5cc or 10 cc syringe
  • Stethoscope
  • Bottle with milk
  • PEG Tube if with stoma
• Elevate the head of the bed and position the infant on the back or side to allow easy passage of the tube.
• Measure the distance from the tip of the nose to the earlobe to the xiphoid process.
• Orogastric insertion is preferable to nasogastric because most infants are obligatory nose breathers. If nasogastric tube is used, a 5 Fr. catheter should be used to minimize airway obstruction.
• If inserting the tube nasally, lubricate the tip in a cup of sterile water. Use water instead of an oil-based lubricant, in case the tube is inadvertently passed into a lung. Shake any excess drops to prevent aspiration.
• Stabilize the infant s head with one hand and pass the tube via the mouth (or nose) into the stomach to the point previously marked. If the infant begins coughing or choking or becomes cyanotic or phonic, remove the tube immediately as the tube has probably entered the trachea
• If respiratory distress is not apparent, lightly tape the tube in position, draw up 0.5cc to 1ml of air in the syringe, and connect the syringe to the tubing. Place the stethoscope over the epigastrium and briskly inject air. You will hear a sudden rush as the air enters the stomach
• Aspirate the stomach contents with the syringe, and note the amount, color, and consistency to evaluate the infantʼ s feeding tolerance. Return the residual to the stomach unless you are requested to discard it. It is usually not discarded because of the potential for electrolyte imbalance
• Hold the infant for feeding, or position the infant on the right side.
• eparate the syringe from the tube, remove the plunger from the barrel, reconnect the barrel to the tube, and pour the formula into the syringe
• Elevate the syringe 6-8 inches over the infantʼ s head, and allow the formula to flow by gravity at a slow, even rate. You may need to initiate the flow of formula by inserting the plunger of the syringe into the barrel just until you see formula enter the feeding tube. Do not use pressure.
• Regulate the rate to prevent sudden stomach distention leading to vomiting and aspiration. Continue adding formula to the syringe until the infant has absorbed the desired volume.
• Clear the tube with 2-3ml of air.
• To remove the tube, loosen the tape, fold the tube over on itself, and quickly withdraw the tube in one smooth motion to minimize the potential for fluid aspiration as the tube passes the epiglottis. If the tube is to be left in, position it so that the infant is unable to remove it. Replace the tube according to hospital policy
• Whenever possible, hold the infant during gavage feeding. If it is too awkward to hold the infant during feeding, be sure to take time for holding the infant after the feeding.
• Offer a pacifier to the infant during the feeding
• Nutritional Considerations

  • Energy - by monitoring weight loss/gain and exact calorie intake
  • Fluids and Electrolytes - BF with water insufficient quantities pre-term to maintain electrolyte balance; monitor serum electrolytes
  • Vitamins and mineral - for weight gain and development
• Factors that may change caloric needs

  illness

  increased seizure activity

  surgery

  changes in medication
• May be incompatible with feeding:

  • Elixirs and suspensions
  • Syrups diluted to prevent clogs
  • Tablets or capsules : enteric-coated must not be crushed , and may alter MOA that causes GI upset
• flush 15-20 cc before feeding
• check residual gastric volume after feeding
• Medications need to be given separately, flush the tube with 15-30 ml of water in between to prevent the clogging tube
• If medication needs to be given on an empty stomach, stop feeding and wait 15 to 30 minutes before administering the drug