Affiliations: Department of Pediatrics, College of Medicine, The
Ohio State University, Columbus, OH, USA | Department of Radiology, Nationwide Childrens
Hospital, Columbus, OH, USA
Note: [] Corresponding author: Leandro Cordero, MD, Division of
Neonatal-Perinatal Medicine, The Ohio State University Medical Center,
Department of Pediatrics, N118 Doan Hall, 410 W. 10th Avenue, Columbus, Ohio
43210-1228, USA. Tel.: +1 614 293 8660; Fax: +1 614 293 7676; E-mail:
Leandro.cordero@osumc.edu
Abstract: Background: Traditionally, orogastric tube (OGt) length of
insertion is determined by nose-earlobe-xyphoid (NEX) measurement. Although
radiography is the gold standard for verification of placement, scarce data are
available for extremely low birth weight (ELBW) infants. Objective: To
correlate OGt placement in ELBW infants with its position in the
gastrointestinal tract by radiography and to establish clinical correlates with
gastrointestinal perforations. Design/methods: Retrospective evaluation
of 290 ELBW infants. The 1st (n=290) and 2nd (n=273) radiographs
following OGt placement were evaluated. Diaphragm and OGt were referenced to
the level of the 10{th} thoracic vertebra (T10). The lower esophageal sphincter
(LES) was presumed to be at T9. Results: Most (86%) OGt were placed
during the first three days of life. OGt pores and the stomach were visible in
37% and 40% of the cases respectively. The diaphragm was noted to be at
T8 (14%), T9 (43%), T10 (41%) & T11 (2%). On the first
radiograph, OGt were in the esophagus (4%), in the duodenum (3%),
straight in the stomach (8%) and diagonal in the stomach (85%). Of
all 563 radiographs evaluated, 502 (89%) OGt were diagonal in the
stomach, extending below the LES for a median 3 cm (0.7–4.9 cm). In the 225
radiographs where the stomach could be visualized, the median distance from T10
to the OGt tip was 2.8 cm (1–5) while that from T10 to the greater curvature
was 3.1 cm (1–5). Clinical correlates: There were 21 cases of
necrotizing enterocolitis (15 of them with perforation) and 7 cases of
spontaneous intestinal perforation. None of them were temporally or
anatomically linked to OGt placement. Conclusions: Radiological
verification of OGt placement is possible. The unpredictable level of the
diaphragm, the poor visibility of OGt pores and the often gasless stomach can
make radiological verification difficult. Determining OGt insertion length in
ELBW infants by the NEX method results in appropriate intragastric placement in
85% of the cases.
