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

Hawes J, McEwan P, McGuire W

Published Online:

April 16, 2008

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 two small trials were found that compared these two options and these did not find convincing evidence to support routine use of one rather than the other.

Abstract (click to read)

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 compared with oral placement of enteral feeding tubes on feeding, growth and development, and the incidence of adverse consequences in preterm or low birth weight infants.

Search strategy:

The standard search strategy of the Cochrane Neonatal Review Group was used. This included searches of the Cochrane Central Register of Controlled Trials (CENTRAL, The Cochrane Library, Issue 4, 2007), MEDLINE (1966 - December 2007), EMBASE (1980 - December 2007), CINAHL (1982 - December 2007), conference proceedings, and previous reviews.

Selection criteria:

Randomised or quasi-randomised controlled trials that compared the use of the nasal versus oral route for placing enteral feeding tubes in preterm or low birth weight infants.

Data collection and analysis:

The standard methods of the Cochrane Neonatal Review Group were used, with separate evaluation of trial quality and data extraction by two authors. Data synthesis using a fixed effects model and reporting typical relative risk, typical risk difference and weighted mean difference was planned.

Main results:

Two small randomised trials were identified. 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 nor the time taken to regain birth weight. However, the trial was underpowered (N= 46) to exclude modest effect sizes.

Authors' conclusions:

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

This record should be cited as:

Hawes J, McEwan P, McGuire W. Nasal versus oral route for placing feeding tubes in preterm or low birth weight infants. Cochrane Database of Systematic Reviews 2004, Issue 3. Art. No.: CD003952. DOI: 10.1002/14651858.CD003952.pub2

Assessed as up to date:

December 27, 2007

Find the research

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Primary Review Group:

Neonatal Group

Health topics:

Neonatal care > Feeding the low birthweight infant > Techniques of feeding

Cochrane Summaries^beta

Independent high-quality evidence for health care decision making

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

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