babies in the ER

Your ER doc is insane. How do they give gavage feeds?- through an NG.

Guess it's safe to assume the infant didn't have facial/head trauma or congenital deformities. I'm trying to understand why the doc would make such a statement. Did he mean "no NGs" in any patient or only in infants? And did you question the doc & ask for reasons supporting the insanity?

BTW...how's the baby?

I'm not sure about the literature, I'd have to check, but when my son was born all his gavage feedings were done via OG not NG, maybe has to do with them being obligate nose breathers....all the babies in the ICN when my son was there had OG gavage, never saw an NG...In my ER under 3 months we do OGs....and then we tegaderm it to their face...did you ask the ER doc why he had you pull it out?? Maybe he had a good reason, before everyone calls him insane...

Well, yeah, generally babies are nose breathers. However, in the NICU we often use NG tubes. We start with OG tubes, but when the baby is old enough to bottle feed, we switch to an NG because it's very hard to feed orally with an OG tube in place. Lots of gagging, no seal on the bottle, and they wiggle out much easier than an NG.

However, I can see and ER doc, not comfortable with newborns, requesting that the tube be placed OG. He doesn't want the baby going into respiratory distress on his shift! What you need to do, if placing an NG on a small baby, is make sure you use the smallest tube possible so it doesn't totally occlude the nare. A 5 or 6 french feeding tube or repogle is best.

NG or OG either would have been appropriate. Unless you used too large a tube that occluded the nare. It was probably something from his peds rotation during residency with an attending with a preference.

Some people have very strong opinions about placing things in the nose of obligate nose breathers. Fact is, they only breath through their mouth when crying. However, I've never seen babies go into resp distress because one of their nares was occluded. Friends who work in the NICU have no problem placing things in the nose, but you have to think about each situation differently.

It is my experience that a full term infant can easily accomodate an 8Fr. ng tube without any negative effects on his/her breathing. A larger tube that completely occludes the nare would not be a good idea, and in that case, an og tube would be preferable.

The notion of obligate nose breathing is a bit of a fallacy, anyway. When babies' nares are blocked, they DO breathe thru their mouths, although you don't want to force a baby to do so if it can be avoided.

Most babies tolerate ng tubes better than og, and are less likely to gag on an ng tube. It was probably for more traumatic to the infant to remove and replace the tube than it would have been to leave it alone!

I recently left a NICU that went to only OG's due to an outbreak of MRSA on the unit. The ID doc said placing NG's was contributing to many of the babies getting it.

No reason to do that- just causes more trauma to the poor child!

NG's on babies are so much easier!!! My first NGT was on a 6weeker.

Thanks for all the info..... as far as I know, the baby is doing well, some kind of GI thing going on (NEC?). anyway, the doc involved was one of those "rent a docs" that doesn't work very often, so next time I see him I will ask more questions. I do know that he is uncomfortable with the tiny ones.......

I recently left a NICU that went to only OG's due to an outbreak of MRSA on the unit. The ID doc said placing NG's was contributing to many of the babies getting it.

Please forgive me if I'm missing something obvious here, as I haven't had my coffee yet. But, how does passing an ng tube contribute to babies getting MRSA? Either they are colonized with it or they aren't, but how does an ng tube make them more susceptible to infection than an og tube? Either tube goes thru their upper airway where the bacteria is likely to be present in a colonized infant.

We do NG and OG on little ones...depends on whether there's an ET as well.

Chip