Overview:
Premature infants are not mature enough to take a bottle or breastfeed. If the infant needs assistance with feeding, the pediatrician may recommend a nasogastric tube (NG tube) that is placed through the nose or the mouth into the stomach. Tube feeding helps your infant get the desired nourishment by supplying essential nutrition and hydration. A nasogastric tube is thin, flexible, and soft. The tube feeds straight into the infant's stomach, and food is digested normally by the infant's digestive system. These tubes are designed in such a way that there will be no discomfort to the baby. Although nasogastric tubes can be used in patients of different ages, they are typically indicated for newborns and children.
What Is a Feeding Tube?
Infants who are unable to feed are given nutrition using feeding tubes, also referred to as gavage tubes. Normally used in hospitals, the feeding tube can also be used at home to feed infants. Additionally, a baby might get medication through the tube.
For each meal, the feeding tube can be inserted and subsequently removed. Another option is an indwelling feeding tube, which stays in the baby for several feedings. Both breast milk and formula can be administered through the feeding tube.
Why Do Infants Need Feeding Tubes?
Babies who cannot self-feed from the breast or bottle must have a feeding tube. To breastfeed or bottle-feed, an infant needs strength and coordination. The infant must be capable of sucking and swallowing from the breast or bottle nipple. A healthcare professional may recommend a feeding tube if a baby cannot breastfeed or feed from a bottle. A feeding tube is recommended if a baby has any of the following conditions:
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No weight gain.
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Patterns of irregular weight gain.
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Lack of or ineffective sucking reflex.
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Absence or ineffectiveness of the swallowing reflex.
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Gastrointestinal defects.
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Electrolyte imbalance and related issues.
It may be difficult for premature or ill newborns to feed themselves. In these circumstances, feeding tubes are a safe and effective method of delivering feeds and medications to the baby.
What Are the Types of Feeding Tubes?
Feeding tubes for feeding come in various forms, which are:
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Nasogastric Tube (NG): This tube is inserted into the stomach through the nose. Usually, it lasts for two to four weeks of feeding.
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Nasojejunal Tube (NJT): A tube is inserted through the nose into the jejunum, a section of the small intestine. If the infant experiences issues emptying the stomach, has undergone pancreatic surgery, or has any obstruction, NJT tubes are advised.
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Jejunostomy Tube (JEJ): A jejunostomy tube (JEJ) is a tube that is put via a belly hole and into the jejunum. It is typically applied to infants with esophageal (food pipe) or gastric (stomach) operations. The two types of tubes are the radiologically placed jejunostomy tube (RIJ) and the percutaneous endoscopic jejunostomy tube (PEJ). While RIJ tubes are X-ray-guided, PEJ tubes are introduced under endoscopic guidance.
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Gastrostomy Tube (G-Tube): This tube is put through a belly hole and into the stomach. Feeding is a common usage for it. Depending on the imaging method, it may be a percutaneous endoscopic gastrostomy tube (PEG) or a radiologically inserted gastrostomy tube (RIG).
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Orogastric Tube (OG): An orogastric tube (OG) is a tube that is inserted into the stomach through the mouth. It serves a similar function as a nasogastric tube. An orogastric tube may be chosen when the infant has nasal issues or has had previous nasal intubations.
Pediatricians decide on the feeding technique and tube type based on the infant's health and condition.
How Is a Feeding Tube Placed?
A feeding tube is carefully inserted into the stomach through the nose or mouth. An x-ray can verify proper positioning. The tube tip may be inserted past the stomach and into the small intestine in infants with trouble feeding. This offers continuous and slower feedings to the infant.
Procedure:
The steps involved in the insertion technique are as follows:
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The nurse will measure the distance from their mouth or nose to their stomach. The tube will then be marked so it is precisely placed to the proper length for the child.
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They will use water-based lubricating gel or sterile water to lubricate the tip.
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The tube will be carefully inserted into the child's mouth or nose. Sometimes doctors will implant the tube, but typically a bedside nurse does it.
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The nurse will examine the placement of the tube once it has been inserted by breathing a little air into it and listening for the contents to enter the stomach.
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This proves that the tube was positioned properly. Withholding some of the liquid from your baby's stomach and using a testing strip to measure the pH is the most accurate approach to verify that the tube is in the proper location without receiving an X-ray. This will guarantee that the tube enters the stomach rather than the lungs.
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It is taped to the mouth or nose to ensure the tube stays in place after being put in. The doctor may use a pectin barrier or paste if the baby has sensitive skin or a skin issue to prevent skin tears when the tape is removed.
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Some systems use cotton tape that runs beneath the nasal bone to fasten the tube internally. Your doctor can ask for an abdominal X-ray of your child to confirm that the tube is in the stomach.
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The infant is fed formula, breast milk, or medication via injection with a syringe or infusion pump after the tube has been securely inserted. While the liquid slowly flows through the feeding tube, the parent can hold the infant.
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The doctor will either cap off the tube or remove it once the feeding is finished. To avoid regurgitation, you should ensure your baby is upright or slightly inclined.
What Are the Risks of an Infant Feeding Tube?
In general, feeding tubes are safe and efficient. However, issues may arise even if the tube is appropriately positioned. These consist of the following:
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Minor bleeding caused by irritation of the nose, mouth, or abdomen
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Nasal congestion or infection if the tube is inserted through the nose.
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If the tube is improperly positioned or misplaced, the infant may experience issues with the following:
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A prolonged heart rate (bradycardia).
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Breathing difficulties.
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Spitting up.
In extremely rare instances, the feeding tube may penetrate the stomach.
How Long Can an Infant Be on a Feeding Tube?
The feeding tube can be left in newborns for months. However, if the tube is removed before one month, the healthcare provider may examine its condition. If the tube is flexible and undamaged, it can be washed and reinserted into the stomach.
If the end of a tube gets hard or damaged, it is replaced. The tube feeding continues until the infant can self-feed or until the feeding issues are resolved by other means.
Pediatricians may put a gastronomy tube or G-tube instead of a nasogastric or orogastric tube if a baby requires feeding tubes for longer due to medical issues. This is accomplished through minor surgical operations and maintained until the infant needs it.
What Will Happen if the Infant Must Leave the Neonatal Unit with a Feeding Tube?
If the infant is discharged with a feeding tube, a unit staff member will demonstrate how to feed and care for the tube. The parent or a community nurse may replace the tube when you return home. This will depend on your baby's requirements, choices, and the unit's level of support.
The baby's feeding tube must be appropriately positioned; otherwise, the food could drain the lungs or throat. Even paying great attention to the instructions, parents may still have difficulties at home while feeding. If so, discuss the concerns with the physician. A home health nurse may be recommended to assist with feeding until one gets comfortable with the process.
Conclusion:
For parents, It might be challenging to feed the child with a feeding tube. It is normal to feel anxious and depressed if the mother cannot breastfeed or bottle-feed the infant. Many infants require feeding tubes until they are healthy or strong enough to feed through the breast or the bottle. However, keep in mind that the condition is never anyone's fault. This is a common medical problem that requires treatment and trust that it will not last forever and will resolve with time.
