This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Feeding by nasointestinal (NI) tube is preferred for many children when the gastrointestinal system is functional, gastric feeding has been determined to be unsafe, and the need for assisted feeding is expected to be short-term. Regardless of the method used to place NI tubes, radiographs are routinely obtained to assure correct tube position prior to initiation of feedings. Subsequently, placement of NI tubes is not routinely checked. An NI tube's distal tip can shift upward from the duodenum into the stomach or even the esophagus, even when the external portion of the tube remains taped in place. This is especially likely when vomiting, severe coughing, or nasotracheal suctioning occurs. When tubes are out of place, children can be seriously harmed, causing increased morbidity. Increasing the safety of NI tube feeding in this population requires knowledge development in two areas-predicting the insertion distance for correct tube placement and maintaining correct tube positioning. This preliminary study is relevant to the second of these knowledge needs. The sample will consist of 50 hospitalized children < 19 years of age having an NI tube already in place. The pH and bilirubin levels of tube aspirate will be measured to detect gastric or intestinal location. Actual tube location will then be determined by abdominal radiograph to assess the adequacy of the placement-locating methods. The goal is to obtain initial estimates of prevalence of displacement, and sensitivity, specificity, positive and negative predictive value of the placement-locating methods to determine sample sizes needed in a future multi-center study. The long-term goal is to find the best clinical method(s) of determining the internal location of NI tubes in children.
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