Predicting the insertion length for gastric tube placement in neonates

Marsha L. Cirgin Ellett, Mervyn D. Cohen, Susan M. Perkins, Coral E. Smith, Kathleen A. Lane, Joan K. Austin

Research output: Contribution to journalArticle

24 Scopus citations


Objective: To compare error rates of three existing methods of predicting the gastric tube insertion length in a group of neonates <1 month corrected age: age-related, height-based (ARHB); direct distance nose-ear-xiphoid (NEX); and direct distance nose-ear-mid-umbilicus (NEMU). Design: Randomized controlled trial. Setting: Five neonatal care units in a large midwestern city. Participants: One hundred and seventy-three hospitalized neonates. Methods: Neonates were randomly assigned to one of three groups: ARHB, NEX, or NEMU. For primary analysis, only tubes placed too high with the tube tip in the esophagus or at the gastroesophageal junction were considered to be misplaced. For secondary analysis, a stricter definition was used, and low placements (pylorus or duodenum) were also considered to be misplaced. All radiographs were blinded and read by a pediatric radiologist. Results: For the primary analysis, the differences in percentages of correctly placed tubes among the three methods was statistically significant (χ2=34.45; p<.0001), with NEMU and ARHB more accurate than NEX (NEMU χ2=18.59, p<.0001; ARHB χ2=21.34, p<.0001). Using the stricter definition for placement, ARHB was not significantly different from NEX (p=0615). A new ARHB equation was developed specific for neonates <1 month corrected age. Conclusions: Direct distance nose-ear-xiphoid should no longer be used as an nasogastric/orogastric (NG/OG) tube insertion-length predictor in neonates. Either NEMU for NG/OG tubes or the new ARHB equation for NG tubes should be used.

Original languageEnglish (US)
Pages (from-to)412-421
Number of pages10
JournalJOGNN - Journal of Obstetric, Gynecologic, and Neonatal Nursing
Issue number4
StatePublished - 2011


  • Enteral feeding
  • Feeding tube
  • Nasogastric tube
  • Neonates
  • Premature infants
  • Randomized controlled trial

ASJC Scopus subject areas

  • Maternity and Midwifery
  • Pediatrics
  • Critical Care

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