Adverse effects of nasogastric feeding tubes and the management of recurrent apnoea.

Correspondence Adverse effects of nasogastric feeding tubes and the management of recurrent apnoea Sir, The role of miconazole in the treatment of systemic candidiasis was clearly described by Tuck' in his report of 2 cases. However, his paper also contained examples of the iatrogenic hazards of neonatal intensive care and these deserve comment. In each case intravenous feeding was given through a centrally placed Silastic cannula because of recurrent apnoea. In Case 1 the sequence of events is clearly documented. From the time that nasojejunal feeds were introduced apnoeic episodes occurred, and on day 29 the baby collapsed after the passage of a nasal feeding tube. Earlier in 1980 Stocks2 described work done at the Hammersmith Hospital which showed that nasal resistance in white infants was increased by 101-138% when a feeding tube was passed through one nostril. She also confirmed the common observation that a nasally-passed tube causes not only physical obstruction but also irritation to the nasal mucosa which results in increased resistance. As most preterm babies are unable to mouth breathe even when both nostrils are fully obstructed the adverse effects of nasally passed tubes on respiration, if overlooked, may lead to further complications of management as described by Tuck. He states that there is an increase in the use of intravenous feeding in the management of preterm infants and that systemic candidiasis can be expected to become more common. This and other complications of intravenous feeding should be avoided. The experience in Oxford suggests that intravenous feeding can be restricted almost exclusively to the few babies in whom necrotising enterocolitis is suspected, and that in preterm infants and others with respiratory distress feeding tubes should always be passed orally. Although apnoeic attacks may occasionally be the result of regurgitation of gastric contents this has never been taken to be an indication to resort to intravenous feeding through a centrally placed catheter. References Tuck S. Neonatal systemic candidiasis treated with miconazole.