Oral versus Nasal Route for Placing Feeding Tubes: No Effect on Hypoxemia and Bradycardia in Infants with Apnea of Prematurity

作者：Bohnhorst Bettina^*; Cech Kathrin; Peter Corinna; Doerdelmann Michael

来源：Neonatology, 2010, 98(2): 143-149.

DOI：10.1159/000279617

• Prematurity
• Hypoxemia
• Bradycardia
• Feeding tube
• Oral/nasal route

Background: Raised upper airway resistance may be involved in apnea of prematurity (AOP). Objectives: To determine the effects of an oral versus a nasal gastric tube on episodes of hypoxemia and bradycardia in infants with AOP. Methods: In a randomized controlled cross-over trial, 32 infants (median gestational age 29 (range 24-31) weeks, post-menstrual age at study 32 (range 30-35) weeks) with the need for tube feeding and symptoms of AOP underwent a 24-hour recording of breathing movements, nasal airflow, heart rate, pulse oximeter saturation and pulse waveforms. A 5-Fr feeding tube was placed orally or nasally for 12 h each, the position selected first was randomly assigned. When the feeding tube was placed nasally, always the smaller nostril was selected. Each infant acted as his/her own control. Recordings were analyzed for the summed rate of bradycardia and desaturation (heart rate <2/3 of baseline, saturation <= 80%). Results: The route of placing the feeding tube had no significant effect on the summed rate of bradycardia and desaturation (nasal route: median 1.6, CI 0.8-1.9; oral route: median 1.0, CI 0.9-1.6, p = 0.25). Conclusion: We could not confirm an advantage of placing a feeding tube orally in these infants with AOP, as the oral route did not improve their symptoms of AOP. Possible explanations include: (i) the increase in nasal airway resistance by the 5-Fr nasogastric tube, inserted into the smaller nostril, is too small to have any effect on AOP; (ii) any benefit of the oral route is neutralized by the negative effects of an enhanced vagal stimulation, or (iii) study duration was too short to detect a difference in AOP.

• 出版日期2010