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Among hospitalized infants and children, nasogastric (NGT) or orogastric (OGT) tubes are most commonly placed in the neonatal intensive care unit [1]. Placement of an NGT or OGT is a blinded procedure. Therefore, it is unknown whether the tip is in the stomach after placement. The position of the NGT/OGT tip is typically confirmed using ultrasound, auscultation, aspirate pH, and capnography [2]. However, there are concerns about most of these methods and their accuracy in neonates, even when using radiography. In addition, the frequent use of radiography results in cumulative radiation doses to infants. The New Options for Enteral Tube Verification project recommended pH measurement as a best practice for verifying NGT placement in children [3]. The group identified a need for products that allow real-time verification and revalidation of placement during NGT use [3]. Hirano et al. reported that the use of a LED light source and fiber optics (LED-SF) enabled safe and easy confirmation of the NGT/OGT tube tip position in adults under general anesthesia [4]. LED-SF allows visualization of a red LED at the tip of the NGT/OGT tube during its insertion into the stomach, eliminating the need for X-rays. The specific objectives of this study were to determine the feasibility of using LED-SF to confirm the position of the NGT/OGT tube tip in the stomach of neonates and to demonstrate the safety of this method.
This prospective observational cohort study evaluated routine NGT/OGT exchanges in ten neonates admitted to a tertiary neonatal intensive care unit (NICU) (Supplementary Table 1). Parents provided consent to participate. The study protocol was approved by the institutional review board of Tokyo Metropolitan Children’s Hospital [2022b-32]. Informed consent was obtained from all parents. LED-SF consists of a plastic optical fiber with a red LED emitting from its tip. LED-SF was first inserted into the NGT/OGT. To prevent the tip of the LED-SF from displacing from the tip of the NGT/OGT, a sliding stopper was used to fix it within 1 cm of the tip. Nine and one neonate underwent NGT and OGT, respectively. The red light emitted by the LED is visible through the mouth and throat, but not in the esophagus (Figure 1A). When entering the stomach, the LED illuminates the entire stomach (Fig. 1B), but as it moves forward it shrinks to a single red dot (Fig. 1C). Depending on the internal diameter of the NGT/OGT, optical fibers with a diameter of 0.5 mm (n = 7) or 0.75 mm (n = 3) were selected.
The red light from the LED is clearly visible as it passes through the mouth and throat (A). Once in the stomach, the LED illuminates the entire organ (B), but as it moves forward it shrinks to a single red dot (C).
In seven neonates, the LED-SF helped the tip of the nasogastric/ogastric tube to reach the correct position; in three, minor adjustments were required (Supplementary Table 1). In the last case, nasogastric tube insertion was inappropriately stopped when the LED illuminated the entire stomach (case 8). The remaining two cases required adjustments of 0.5 cm or 1.0 cm in the nasogastric tube position. No adverse or hazardous events were observed during the procedure. Technical problems such as fiber breakage or light leakage from the source were not encountered during use.
This is the first report in the literature demonstrating safe and accurate placement of gastritis, duodenum and duodenum (GD) catheters using a light-emitting diode (LED-SF) candle lamp. In this study, the tip of the GD catheter was clearly visible as a red dot in the stomach of both preterm and term neonates.
Perforation or dislocation of NGT/OGT during insertion into the stomach or esophagus is a serious complication with a mortality rate of up to 25.8% [5]. If perforation occurs, LED-SF is expected to illuminate not only the stomach but also the entire abdominal cavity. Esophageal perforation in particular is an important and serious complication with a prevalence (0.05%) in preterm infants with a birth weight <1500 g and/or gestational age ≤32 weeks. In this study, the insertion method of NGT/OGT was similar to the conventional method and was not expected to increase or decrease the risk of perforation. However, when using LED-SF, the red LED can indicate that the tip of NGT/OGT has safely passed through the throat and entered the stomach correctly, without the need for radiographic examination. This is the biggest advantage. In addition, the frequency of radiographic examination may be less. The small sample size is a limitation of our study.
We demonstrated the safety and efficacy of using LED-SF to verify correct nasogastric tube (NGT/OGT) placement in neonates. This technology allows staff to monitor the tube tip in real time during placement. Further studies with larger sample sizes are needed to confirm the results of this pilot study and demonstrate the feasibility of LED-SF in neonates requiring NGT or OGT placement.
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JK designed the study and wrote the first draft of the manuscript. KO supervised the writing and editing of the manuscript. Both authors approved the submission of the manuscript and agree to be accountable for all aspects of the study and to ensure that any questions related to the accuracy or integrity of any part of the study are appropriately investigated and resolved.
The Ethics Committee of Tokyo Metropolitan Children’s Medical Center approved the study protocol.
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Kuroda, J., Okazaki, K. Pilot study using fiber optic light to guide nasogastric/orogastric tube placement in neonates. Journal of Perinatal Medicine 43, 1179–1180 (2023). https://doi.org/10.1038/s41372-023-01668-7
Post time: Sep-05-2025