SAFETY AND EFFICACY OF NASOJEJUNAL TUBE PLACEMENT AND FEEDING IN CRITICALLY ILL INFANTS.

Abstract

Background The use of a nasojejunal tube (NJT) allows for enteral feeding in patients at risk of severe gastroesophageal reflux. There have been no published data directly addressing the safety and efficacy of NJT placement and feeding in the critically ill infant. Objective To assess the safety and efficacy of NJT placement and feeding in critically ill infants. Methods All consecutive fluoroscopic NJT insertion, by a trained pediatric interventional radiologist, in infants cared for at the Children9s Hospital Los Angeles Center for Newborn and Infant Critical Care between January 2003 and June 2006 were identified. Demographic and clinical variables were collected. Chronological age at the time of NJT placement, length of NJT feeding, and the incidence of significant complications attributable to NJT placement (gastrointestinal perforation, obstruction, or hemorrhage) were identified. Results Sixty-eight of the 82 charts reviewed had complete clinical information. The average postmenstrual age at the time of initial NJT placement was 45 weeks (range 28-115 weeks). Ninety-five percent (65 of 68) of infants had successful NJT placement. No complications (gastrointestinal perforation, obstruction, or hemorrhage) associated with NJT placement were identified. The average time on NJT feeds was 47 days (range 3-256 days) and the average time to reach full feeds was 31 days (range 0-130 days). On average, each infant required two separate NJT insertions during their hospitalization. Conclusion Use of NJT, inserted by a trained pediatric interventional radiologist, appears safe in critical ill infants and is not associated with serious gastrointestinal complications. When gastric feeding cannot be initiated in critically ill infants, NJT feedings may serve as an alternative safe approach to enteral feeding.