P2C074: Point of Care Ultrasound (POCUS) as an Alternative to X-ray for Confirming Feeding Tube Placement in Neonates: A Feasibility Study

Background: Naso-gastric (NG) and Oro-gastric (OG) tube insertion is a standard bedside procedure in the care of neonates in the NICU and X-ray is currently used as the gold standard for confirming OG/NG position in the stomach. The American Academy of Pediatrics in collaboration with the Committee on Fetus and Newborn and Section on Radiology recently published guidelines defining the scope of practice for POCUS in pediatrics and neonates. There are limited studies on the use of POCUS as an alternative to X-ray in confirming feeding tube position in Neonates. Our objectives: were to determine the diagnostic accuracy/feasibility of POCUS in confirming feeding tube position between two non-radiologist clinicians at different levels of training/experience and evaluate the generalizability of our POCUS protocol for confirming OG/NG tube position in neonates admitted to a level III NICU in an academic setting.

Methods: This is a prospective, observational, feasibility study. Stable infants ≥ 30 weeks were enrolled. Feeding tubes were placed and confirmed by X-ray as per unit protocol. Two clinicians (attending and fellow) trained in POCUS and blinded to x-ray results, obtained 2 images/patient (transverse supraglottic and epigastric longitudinal tilted view) to identify OG/NG ( < 48 hrs from last xray) using GE venue 50 [linear (8-11Mhz); curved array (4-8 MHz) probe] Image1. A pediatric radiologist blinded to study subjects and x-ray then evaluated and compared the images.

Results: n=51, 102 US studies, median GA 34(±3.8) weeks; mean BW 2063(±940) grams. Avg. time to obtain/ interpret images was 1.18 (± 0.47) mins. Table 1 shows the POCUS comparison between the two clinicians. Both made correct selections for probes, presets, and appropriate adjustments for image gain and depth with the proper orientation of the marker. Both clinicians had higher quality images in the epigastric view (94%-96%) Vs supraglottic view (88%-90%). One tube was identified in the lower esophagus and was confirmed by the radiologist. Therefore, was considered a true negative value. Two images were confirmed by X-ray to be in a good position, but the radiologist could not confirm the US images (poor quality) due air interposition in the stomach and were considered false negative results. Sensitivity was 98%, specificity of 100%, PPV was 100%, and NPV of 34%.

Conclusion: Structured POCUS training enhances clinical skills at all experience levels. We found no difference in the accuracy/interpretation of POCUS images for confirming OG/NG tube position between attending and fellow, highlighting the generalizability of our POCUS protocol and training. Larger studies are needed to support our results & refine POCUS protocols further.