Desaturation events during oral feedings with and without a nasogastric tube in very low birth weight infants

OBJECTIVE: To examine the desaturation events with the presence and absence of a nasogastric tube during an entire oral feeding in 20 very low birth weight (VLBW) infants. DESIGN: Prospective, quasi-experimental, random assignment. SETTING: Midwestern, university-affiliated, tertiary neonatal medical center. PATIENTS: Twenty VLBW infants without severe neurologic problems or physical anomalies. On the day of the study, postnatal days were 17 to 82 days (49 ± 18.91). OUTCOME MEASURES: Desaturation events. INTERVENTION: These infants were observed during oral feedings, once with a nasogastric tube and once without, at 9 AM and 3 PM feedings within 1 day, decided in random order. RESULTS: Fifteen infants experienced 166 desaturation events (< 90%), 83 desaturation events without the nasogastric tube, and 83 events with the nasogastric tube present. Infants for whom desaturation events developed had a longer transition period from tube feedings to oral feedings (p < 0.05), and started feedings with lower oxygen saturation (p < 0.05). Nearly all desaturation events (97%) occurred with breathing pauses (11.32 ± 6.67 seconds), a change in heart rate, and an increase in end-tidal CO₂. The presence of a nasogastric tube increased the duration of desaturation by an average of 8 seconds (p < 0.05). CONCLUSION: Infants' oxygen saturation needs to be monitored with feedings, and feedings may need to be started with a baseline lowest saturation of 95% or higher, monitored with breathing and heart rate to prevent desaturation.