Pilot study using an optical fiber light source to guide nasogastric/orogastric tube insertion in neonates

Among hospitalized infants and children, the frequency of nasogastric tube (NGT) or orogastric tube (OGT) placements is highest in neonatal intensive care units [1]. NGT or OGT placement is

a blind procedure. Therefore, it is not known whether the tip is positioned in the stomach after insertion. The NGT/OGT tip position is typically confirmed by methods including

ultrasonography, auscultation, the pH of aspirate, and capnography [2]. However, there are concerns about most of these methods and their accuracy in a neonate, even x-ray. Moreover,

frequent use of x-ray results in cumulative radiation doses in infants. The New Opportunities for Verification of Enteral tube Location project recommends pH measurement as the best practice

for NGT placement verification in children [3]. This group proposed the need for product development to allow for placement verification and reverification in real time for the duration of

NGT use [3]. Hirano et al. reported that using a light-emitting diode source and fiber (LED-SF) could confirm NGT tip positioning safely and simply in adults under general anesthesia [4].

LED-SF enabled NGT/OGT insertion into the stomach while viewing a red LED light at the tip of NGT/OGT without the need for a confirmatory x-ray. The specific aim of this study was to

determine whether using LED-SF confirmed NGT/OGT tip in the stomach in neonates and to document the safety of this technology. METHODS The prospective, observational cohort study examined

routine NGT/OGT replacements conducted in ten infants at a level III NICU (Supplementary Table 1). Consent to participate was obtained from the subjects’ parents. The study protocol was

approved by the Institutional Review Board of Tokyo Metropolitan Children’s Medical Center [2022b-32]. Informed parental consent was obtained for all patients. The LED-SF consisted of

plastic optical fibers capable of lighting the tip as a red LED light. The LED-SF was first inserted into the NGT/OGT. Movement of the LED-SF tip from the NGT/OGT tip was prevented using a

slide stopper, which fixed the position of the LED-SF tip at <1 cm from the NGT/OGT tip. NGT and OGT were used in nine and one neonates, respectively. The red light emitted by the LED was

visible as it passed through the mouth and throat but was not visible in the esophagus (Fig. 1A). Upon entering the stomach, the LED light illuminated the entire organ (Fig. 1B) but

contracted to a red dot with advancement (Fig. 1C). Based on the internal diameter of the NGT/OGT, a 0.5-mm diameter fiber (_n_ = 7) or a 0.75 mm fiber (_n_ = 3) was selected. RESULTS The

LED-SF guided NGT/OGT tip to the correct position in the seven neonates and the position required slight adjustment in the three neonates (Supplementary Table 1). In the latter, NGT

insertion was inappropriately paused when the LED illuminated the entire stomach (case 8). In the remaining two cases, the GT positioning required an adjustment of 0.5 or 1.0 cm. No adverse

or safety events were observed during any procedure. No technical problems were encountered with its use, such as fiber breakage or light source leakage. DISCUSSION This is the first report

in the literature demonstrating the safe and accurate NGT/OGT insertion using an LED-SF. In this study, the NGT/OGT tip was clearly visible as a red dot in the stomach of preterm or term

neonates. Perforations or misplacement related to the insertion of NGT/OGT in the stomach or esophagus are serious complications with mortality rates of up to 25.8% [5]. If perforation

happened, the LED-SF would be expected to light not only the stomach but also the entire abdomen. In particular, esophageal perforation is an important and serious complication with a

prevalence of (0.05%) in preterm infants with birth weight <1500 g and/or with gestational age ≤32 weeks. In this study, the insertion method of NGT/OGT was similar to the usual method

and would not be expected to increase or decrease the risk of perforation. However, using LED-SF, the red LED light informed that the NGT/OGT tip safely passed the throat and correctly

entered into the stomach without an x-ray. This is the strongest advantage. Furthermore, the frequency of x-ray may be less. The small sample size is our study limitation. CONCLUSION We have

demonstrated the safety and efficacy of an LED-SF to verify NGT/OGT placement in neonates. This technology gives staff real-time information about the movement of the tube tip during

placement. Future studies in a larger cohort are necessary to validate the results derived in this pilot study and to demonstrate the feasibility of widespread use of LED-SF in neonates who

require an NGT or OGT. REFERENCES * Lyman B, Kemper C, Northington L, Yaworski JA, Wilder K, Moore C, et al. Use of temporary enteral access devices in hospitalized neonatal and pediatric

patients in the United States. JPEN J Parenter Enter Nutr. 2016;40:574–80. Article  Google Scholar  * Irving SY, Lyman B, Northington L, Bartlett JA, Kemper C. Nasogastric tube placement and

verification in children: review of the current literature. Crit Care Nurse. 2014;34:67–78. Article  PubMed  Google Scholar  * Irving SY, Rempel G, Lyman B, Sevilla WMA, Northington L,

Guenter P. Pediatric nasogastric tube placement and verification: best practice recommendations from the NOVEL project. Nutr Clin Pract. 2018;33:921–7. Article  PubMed  Google Scholar  *

Hirano H, Masaki H, Kamada T, Taniguchi Y, Masaki E. Biologically transparent illumination is a safe, fast, and simple technique for detecting the correct position of the nasogastric tube in

surgical patients under general anesthesia. PLoS One. 2021;16:e0250258. Article  CAS  PubMed  PubMed Central  Google Scholar  * Elgendy MM, Othman H, Aly H. Esophageal perforation in very

low birth weight infants. Eur J Pediatr. 2021;180:513–8. Article  PubMed  Google Scholar  Download references ACKNOWLEDGEMENTS The authors thank James R. Valera for his assistance with

editing this manuscript. AUTHOR INFORMATION AUTHORS AND AFFILIATIONS * Department of Neonatology, Tokyo Metropolitan Children’s Medical Center, Tokyo, Japan Jumpei Kuroda & Kaoru Okazaki

Authors * Jumpei Kuroda View author publications You can also search for this author inPubMed Google Scholar * Kaoru Okazaki View author publications You can also search for this author

inPubMed Google Scholar CONTRIBUTIONS JK designed the study and prepared the first draft of the manuscript. KO supervised the writing and revision of the manuscript. Both authors approved

the submission of the manuscript and agreed to be accountable for all aspects of the work by ensuring that questions related to the accuracy or integrity of any part of the work were

appropriately investigated and resolved. CORRESPONDING AUTHOR Correspondence to Kaoru Okazaki. ETHICS DECLARATIONS COMPETING INTERESTS The authors declare no competing interests. ETHICS

APPROVAL The Ethics Committee of the Tokyo Metropolitan Children’s Medical Center approved the study protocol. ADDITIONAL INFORMATION PUBLISHER’S NOTE Springer Nature remains neutral with

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source to guide nasogastric/orogastric tube insertion in neonates. _J Perinatol_ 43, 1179–1180 (2023). https://doi.org/10.1038/s41372-023-01668-7 Download citation * Received: 18 November

2022 * Revised: 22 March 2023 * Accepted: 27 March 2023 * Published: 05 April 2023 * Issue Date: September 2023 * DOI: https://doi.org/10.1038/s41372-023-01668-7 SHARE THIS ARTICLE Anyone

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