Predicting the insertion length for gastric tube placement in neonates

J Obstet Gynecol Neonatal Nurs. 2011 Jul-Aug;40(4):412-21. doi: 10.1111/j.1552-6909.2011.01255.x. Epub 2011 Jun 3.


Objective: To compare error rates of three existing methods of predicting the gastric tube insertion length in a group of neonates <1 month corrected age: age-related, height-based (ARHB); direct distance nose-ear-xiphoid (NEX); and direct distance nose-ear-mid-umbilicus (NEMU).

Design: Randomized controlled trial.

Setting: Five neonatal care units in a large midwestern city.

Participants: One hundred and seventy-three hospitalized neonates.

Methods: Neonates were randomly assigned to one of three groups: ARHB, NEX, or NEMU. For primary analysis, only tubes placed too high with the tube tip in the esophagus or at the gastroesophageal junction were considered to be misplaced. For secondary analysis, a stricter definition was used, and low placements (pylorus or duodenum) were also considered to be misplaced. All radiographs were blinded and read by a pediatric radiologist.

Results: For the primary analysis, the differences in percentages of correctly placed tubes among the three methods was statistically significant (χ(2) =34.45; p<.0001), with NEMU and ARHB more accurate than NEX (NEMU χ(2) =18.59, p<.0001; ARHB χ(2) =21.34, p<.0001). Using the stricter definition for placement, ARHB was not significantly different from NEX (p=.0615). A new ARHB equation was developed specific for neonates <1 month corrected age.

Conclusions: Direct distance nose-ear-xiphoid should no longer be used as an nasogastric/orogastric (NG/OG) tube insertion-length predictor in neonates. Either NEMU for NG/OG tubes or the new ARHB equation for NG tubes should be used.

Publication types

  • Comparative Study
  • Multicenter Study
  • Randomized Controlled Trial
  • Research Support, N.I.H., Extramural

MeSH terms

  • Enteral Nutrition / instrumentation
  • Enteral Nutrition / methods*
  • Esophagogastric Junction / anatomy & histology
  • Esophagogastric Junction / diagnostic imaging
  • Evidence-Based Practice
  • Female
  • Humans
  • Infant, Newborn
  • Intubation, Gastrointestinal / instrumentation
  • Intubation, Gastrointestinal / methods*
  • Male
  • Medical Errors / statistics & numerical data*
  • Radiography
  • Single-Blind Method