title: Indicators of postpyloric feeding tube placement in children.
abstract: OBJECTIVE
  To determine the validity of five indicators (color, pH, and concentrations of bilirubin, pepsin, and trypsin in aspirated gastrointestinal secretions) in predicting postpyloric placement of feeding tubes in critically ill children.
  
  
  METHODS
  Prospective, observational study.
  
  
  METHODS
  University teaching hospital.
  
  
  METHODS
  A total of 96 gastrointestinal aspirates were obtained from 53 children requiring placement of a nasoenteric feeding tube.
  
  
  METHODS
  Feeding tubes were aspirated by applying suction with a 20-mL syringe. Repeat aspirates from the same patient were obtained on different days. All aspirations were performed within 30 mins of obtaining a radiograph to assess tube position.
  
  
  RESULTS
  Aspirates were inspected visually for color. pH and bilirubin concentrations were determined at the bedside by using reagent strips. Pepsin and trypsin concentrations were measured spectrophotometrically in a research laboratory. The sensitivity, specificity, predictive values, and efficiency for each indicator and their 95% confidence intervals were determined based on the position of the feeding tube on the radiograph. Aspirate pH > or =6 had the lowest positive predictive value (76%, range 67% to 85%) but high negative predictive value (94%, range 89% to 99%) for determining postpyloric positioning of the feeding tube. Bilirubin concentration > or =5 mg/dL (> or =86 micromol/L) had the highest positive predictive value (96%, range 91% to 100%) and lowest negative predictive value (88%, range 81% to 95%). Overall efficiency was best for the appearance of a clear yellow aspirate color (93%, range 88% to 98%), pepsin concentration < or =20 microg/mL (94%, range 89% to 99%), and trypsin concentration > or =50 microg/mL (94%, range 89% to 99%).
  
  
  CONCLUSIONS
  Simple bedside assessment of gastrointestinal aspirate color, pH, and bilirubin concentration is useful for predicting feeding tube position. Use of these tests may reduce the number of radiographic studies needed to confirm postpyloric positioning. Laboratory-determined pepsin and trypsin concentrations predict tube position with a high degree of accuracy. Development of simple and inexpensive bedside tests for the detection of gastrointestinal enzymes may be useful.
authors.affiliation: Department of Pediatrics, Children's Hospital of Michigan, Wayne State University School of Medicine, Detroit 48201, USA.
authors.forename: V
authors.initials: V
authors.lastname: Gharpure
authors.forename: K L
authors.initials: KL
authors.lastname: Meert
authors.forename: A P
authors.initials: AP
authors.lastname: Sarnaik
authors.forename: N A
authors.initials: NA
authors.lastname: Metheny
mesh_terms: D000293:Adolescent; D000328:Adult; D002648:Child; D002675:Child, Preschool; D016638:Critical Illness / Q000628:therapy*; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007441:Intubation, Gastrointestinal / Q000379:methods*; D008297:Male; D011446:Prospective Studies; D011708:Pylorus