July 31, 2023
Babies in the Neonatal Intensive Care Unit (NICU) often require a gastric tube during their hospital stay. This can be either an orogastric (OG) tube or a nasogastric (NG) tube. An orogastric tube is a thin flexible tube that is inserted into a baby’s mouth and down their oesophagus to its final destination in the baby’s stomach. The medical team then aspirates (sucks out) a tiny bit of fluid from the stomach and tests it on a PH strip to ensure the tube is in the right place. A NG tube is much the same, but it gets inserted into the nose, past the nasopharynx and down the oesophagus into the stomach instead of through the baby’s mouth. There are many different reasons that a baby may require an OG/NG tube during their hospital stay, and even sometimes when discharged home.
A NG tube is generally preferred by the health care team as it is more easily secured and does not interfere with oral feeding (breast or bottle) or even sucking on a pacifier. However, when a baby is on respiratory support from a continuous positive airway pressure machine (CPAP) via their nose, they are required to have an orogastric tube because the CPAP prongs fit snugly inside their nostrils and there is no extra room for an NG. Also, if a baby is requiring this type of respiratory support it is unsafe for them to orally feed and the baby relies on the orogastric tube for full feeds. Once the baby progresses to a different form of respiratory support such as Nasal High Flow or Low flow oxygen, the prongs are much smaller and allow for additional NG tube placement.
Most of the babies requiring an OG/NG are babies who are born prematurely, usually less than 36 weeks gestation. Premature babies often have feeding difficulties and tire easily with breast or bottle feeds. This means that they are unable to consume enough calories to grow effectively. They can also have trouble coordinating their suck, swallow and breath reflex so, sometimes oral feeding is unsafe. Premature babies are also more likely than term babies to require respiratory support. When a baby requires this support, they will need an OG/NG for feeds, but also to vent any extra air that gets pushed into their tummy from that respiratory support. If that isn’t provided they can become very bloated and uncomfortable.
Babies born at full term may also require an OG/NG tube in the NICU. Sometimes they have difficulty transitioning to life outside their mother’s womb and require respiratory support like their preterm friends. When a baby has respiratory distress, it is unsafe for them to breast or bottle feed. Respiratory distress usually presents with an increased work of breath and respiration rate, meaning they are breathing fast and working hard to breath. When a baby showing these signs is offered oral feeds, the risk that the baby accidently breaths in some of the milk, or aspirates, is too high. It is preferable that they get the feeds directly into their tummy via the NG tube. These babies also generally require nasal CPAP and need this tube for venting the air out of their tummy. Other times a baby may have trouble maintaining their blood sugars after birth and need a few extra calories to do so. These babies are always offered oral feeds first, but sometimes they are unable to do so just after birth and need a little extra help.
There are other more complicated instances where a baby would require an OG/NG. Some babies are born with neurological conditions that impair their ability to suck. Some babies have anatomical differences such as a cleft lip/palate or a choanal atresia (a blockage in their nasal passage) that makes oral feeding more difficult. Babies who have undergone abdominal surgery or have suspected gut problems may require a gastric tube for gut rest rather than feeding. This means that the tube is used to aspirate or suck out all the contents of the stomach so that the bowel has time to heal. In this case, a baby would need intravenous nutrition, a mixture of complex sugars, vitamins and fats given via and intravenous line directly into the baby’s vein.
In conclusion, a baby requiring an OG/NG tube while in NICU is common and can be required for many reasons. The medical team is skilled at inserting and maintaining these tubes and the parents often help. Some babies even go home with a feeding tube in situ if their parents are comfortable so they can practice oral feeds in the comfort of their own home.
Taylor Harrington, NICU Intensive Care Nurse, Auckland, New Zealand