Achievement of full oral feeding in preterm infants using a nasogastric or an orogastric tube: a randomized comparative study

Background: The commonly used orogastric tube (OG) is prone to displacement, thus could cause oral irritation, vagal stimulation, and potential delay in successful oral feeding (OF). Meanwhile, nasogastric tube (NG) feeding may cause respiratory compromise. Therefore, the appropriate route of tube feeding in infants remains controversial. Objectives: To compare NG versus OG feeding regarding time to full OF (FOF), tube displacement and dislodgement, apnea, and aspiration. Design, Setting, and Participants: This randomized comparative study was conducted at a university hospital in Thailand from May 2022 to December 2023. The study enrolled clinically stable preterm infants born at gestational age (GA) <32 weeks. Methods: The enrolled infants were randomly allocated to receive NG or OG during the transition period from gavage to FOF. OF was started at postmenstrual age (PMA) >34 weeks and adjusted according to our feeding protocol until FOF was achieved. Main outcomes and measures: The primary outcome was the time taken to reach FOF. Secondary outcomes included unintentional feeding tube displacement and dislodgement, the incidence of apnea and aspiration pneumonia, and daily weight gain. Results: The NG and OG groups comprised 47 and 47 infants. There were no significant differences between the two groups regarding mean (SD) GA 30.1 (1.9) vs. 29.8 (2.4) weeks, birth weight 1,299 (349) vs. 1,328 (440) g, and PMA at OF started 34.5 (0.87) vs. 34.4 (0.72) weeks. Infants in the NG group achieved FOF significantly sooner (median [IQR] 7 [6, 9] vs. 10 [8, 13] days; p < 0.001) and had lower occurrences of tube displacement (38.3% vs. 82.9%, p < 0.001) and tube dislodgement (17% vs. 63.8%, p < 0.001). No differences in the episodes of apnea and aspiration, and weight gain were observed. Conclusions: Compared with OG, using NG during feeding transition in stable preterm infants resulted in earlier FOF and less feeding tube displacement and dislodgement without significantly different complications.