Orogastric Feeding Research Articles

A Simple Modification of the Intermittent Gavage Feeding Technique in Low-Birth-Weight Infants

We appreciated the article by Pereira and Lemons,1 the subsequent correspondence of Minoli and Moro,2 and Lemons' reply.3 We would like to suggest a simple modification of the intermittent gavage feeding technique in low-birth-weight infants in use in our division. A syringe without the barrel is connected to the orogastric feeding tube and suspended from the top of the incubator. Formula or breast milk is placed in the syringe in the amount required; it then falls by gravity, thus avoiding sudden abdominal distention.4,5

571 CONSERVATIVE MANAGEMENT OF ESOPHAGEAL AND PHARYNGEAL PERFORATIONS IN THE NEWBORN

Perforation of the pharynx or esophagus is a well-described condition in the neonatal period. Controversy exists, however, whether medical or surgical therapy is the most appropriate management of such perforations. Eight cases of neonatal pharyngeal/esophageal perforation in premature infants were treated medically with antibiotics, nutritional support and closed chest-tube drainage of pneumothoraces. The times of perforation varied from 1-10 days of life and were usually associated with passage of oro-gastric feeding tubes. All perforations healed without surgical repair. No mortality or morbidity occurred in any of our patients secondary to these perforations. A review of these eight cases, and an additional seventy-four cases from the literature, revealed no difference in outcome between early surgical intervention and medical management. While certain complications such as mediastinal mass formation are definite indications for surgical drainage, most neonatal perforations of the pharynx or esophagus can be initially managed medically. Medical therapy with close observation for signs of sepsis and/or mediastinal changes will enable most newborn infants to avoid the stress of surgery and identify those infants where surgery is definitely indicated.

NARCOTIC DEPRESSION, FEEDING TECHNIQUES, AND LOWER ESOPHAGEAL SPHINCTER (LES) PRESSURES IN NEWBORN INFANTS

Previous reports suggest that neonates subjected to maternal narcotic depression (MND) and/or fed by conventional orogastric feeding techniques are at high risk for aspiration pneumonia. We have evaluated this risk by determining LES pressure in 16 neonates of 30-42 weeks gestational age (GA). Neonates were fed 20 cal/oz. commercial similac in consecutive 24 hour time periods by intermittent gastric Ravage, continuous drip gastric gavage, and by continuous drip duodenal gavage. Before termination of each feeding period, LES pressures were determined using a single lumen side opening perfused catheter system currently being investigated at our institution.Narcotic depression was mimicked with 50 mg/kg body weight chloral hydrate given orally and LES pressure measurements were repeated in 90 min. After completion of LES studies at termination of the continuous drip duodenal period, the duodenal side opening feeding catheter was perfused with water at a rate of 1.3 ml/min. and pyloric sphincter (PS) pressures were recorded.The results obtained revealed that LES pressures are not affected by GA, mimicked MND, or the type of feeding technique utilized. Although we have demonstrated a functionally competent PS in the preterm infant as immature as 30 weeks GA, all preterm infants studied exhibited a competent LES and no advantages of nasoduodenal drip feedings are apparent.

Orogastric supplementation in small premature infants requiring mechanical respiration.

Very small premature infants with severe respiratory disease were managed with early intermittent orogastric feedings combined with infusion of 10% dextrose. Nine infants weighing less than 1,350 gm at birth (mean, 990 gm) who required endotracheal intubation and respirator therapy and who remained in the hospital for at least 40 days were studied retrospectively. The mean weight gain per day was 10.8 gm for the first 40 days of life, 14.1 gm while an endotracheal tube was in place (sometimes longer than 40 days), and 15.7 gm during the growth phase, after initial weight loss. Individual growth curves compared favorably with those reported by others using total parenteral nutrition. The technique described deserves wider application for initial management of the small premature infant receiving mechanical respiration.