title: Predicting the insertion length for gastric tube placement in neonates.
abstract: 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).
  
  
  METHODS
  Randomized controlled trial.
  
  
  METHODS
  Five neonatal care units in a large midwestern city.
  
  
  METHODS
  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 (χ(2) =34.45; p<.0001), with NEMU and ARHB more accurate than NEX (NEMU χ(2) =18.59, p<.0001; ARHB χ(2) =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.
authors.affiliation: School of Nursing, Indiana University, 1111 Middle Drive, Rm. 439, Indianapolis, IN 46202-5107, USA. mlellett@iupui.edu
authors.forename: Marsha L
authors.initials: ML
authors.lastname: Cirgin Ellett
authors.forename: Mervyn D
authors.initials: MD
authors.lastname: Cohen
authors.forename: Susan M
authors.initials: SM
authors.lastname: Perkins
authors.forename: Coral E
authors.initials: CE
authors.lastname: Smith
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Lane
authors.forename: Joan K
authors.initials: JK
authors.lastname: Austin
mesh_terms: D004750:Enteral Nutrition / Q000295:instrumentation / Q000379:methods*; D004943:Esophagogastric Junction / Q000033:anatomy & histology / Q000000981:diagnostic imaging; D055317:Evidence-Based Practice; D005260:Female; D006801:Humans; D007231:Infant, Newborn; D007441:Intubation, Gastrointestinal / Q000295:instrumentation / Q000379:methods*; D008297:Male; D019300:Medical Errors / Q000706:statistics & numerical data*; D011859:Radiography; D016037:Single-Blind Method