Development of a nonintermediate-incision ventriculoperitoneal shunt procedure using a nasogastric feeding tube for infant patients with hydrocephalus: technical note

Intermediate incisions are considered necessary to pass a catheter tube from the head to the abdomen in ventriculo-peritoneal (VP) shunting via a frontal bur hole. However, an intermediate incision can sometimes become dehiscent, resulting in CSF leakage or infection of the shunt system in the early period after shunt implantation, particularly in infant patients. In this article, the authors describe a novel method of VP shunt insertion that does not require an intermediate incision. This nonintermediate-incision VP shunt procedure was performed in 3 infant patients with hydrocephalus and was not associated with any complications. This method can eliminate the intermediate incision, which is a disadvantage of VP shunt insertion via a frontal bur hole.

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Choroid plexus coagulation in infants with extreme hydrocephalus or hydranencephaly

Journal of Neurosurgery Pediatrics ◽

10.3171/2014.3.peds13488 ◽

2014 ◽

Vol 14 (1) ◽

pp. 55-57 ◽

Cited By ~ 12

Author(s):

Sylvia Shitsama ◽

Nunthasiri Wittayanakorn ◽

Humphrey Okechi ◽

A. Leland Albright

Keyword(s):

Choroid Plexus ◽

Medical Records ◽

Congenital Hydrocephalus ◽

Shunt Insertion ◽

Radiographic Images ◽

Vp Shunt ◽

Shunt Placement ◽

Csf Leakage ◽

Lost To Follow Up ◽

Severe Hydrocephalus

Object Severe hydrocephalus and hydranencephaly are common congenital conditions in Kenya. In patients with these conditions, ventriculoperitoneal (VP) shunts are associated with appreciable complications and endoscopic third ventriculostomies (ETVs) have limited success. Endoscopic choroid plexus coagulation (CPC) to diminish CSF production is a potential treatment option. The purpose of this study was to evaluate the effect of CPC without ETV in infants with severe hydrocephalus or hydranencephaly. Methods Medical records of infants with severe congenital hydrocephalus or hydranencephaly who underwent CPC in Kijabe Hospital from November 2010 to April 2013 were reviewed retrospectively. Thirty-three patients with complete medical records and preoperative radiographic images were identified. After CPC, the infants were followed in the Kijabe Hospital outpatient department, in mobile clinics, or by telephone. Success of the CPC was defined as resolution of preoperative symptoms, stabilization of head size, and avoidance of VP shunt placement. Results Patients were followed from 30 to 608 days (median of 120 days). Three patients were lost to follow-up. Of the 30 evaluable patients, CPC was considered to be successful in 13 (43.3%), including 8 of 20 patients with severe hydrocephalus and 5 of 10 with hydranencephaly. Failure of CPC was evident from increased head circumference in 14 (82%) of 17 patients and from CSF leakage in 3. Of the 17 failures, 13 occurred within 3 months of surgery. Six patients died: 3 whose CPC procedures were failures, 2 whose CPC was successful, and 1 postoperatively. Of the 17 in whom CPC failed, 10 subsequently underwent VP shunt insertion. Conclusions CPC stabilizes macrocephaly in approximately 40% of infants with severe congenital hydrocephalus and hydranencephaly and can be considered as an alternative to VP shunt placement.

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Selecting pH cut-offs for the safe verification of nasogastric feeding tube placement: a decision analytical modelling approach

BMJ Open ◽

10.1136/bmjopen-2017-018128 ◽

2017 ◽

Vol 7 (11) ◽

pp. e018128 ◽

Cited By ~ 3

Author(s):

Melody Zhifang Ni ◽

Jeremy R Huddy ◽

Oliver H Priest ◽

Sisse Olsen ◽

Lawrence D Phillips ◽

...

Keyword(s):

Care Pathway ◽

Feeding Tube ◽

Tube Placement ◽

X Rays ◽

Clinical Environment ◽

Nasogastric Feeding ◽

Relative Safety ◽

Checking Procedure ◽

The Impact ◽

Modelling Approach

ObjectivesThe existing British National Patient Safety Agency (NPSA) safety guideline recommends testing the pH of nasogastric (NG) tube aspirates. Feeding is considered safe if a pH of 5.5 or lower has been observed; otherwise chest X-rays are recommended. Our previous research found that at 5.5, the pH test lacks sensitivity towards oesophageal placements, a major risk identified by feeding experts. The aim of this research is to use a decision analytic modelling approach to systematically assess the safety of the pH test under cut-offs 1–9.Materials and methodsWe mapped out the care pathway according to the existing safety guideline where the pH test is used as a first-line test, followed by chest x-rays. Decision outcomes were scored on a 0–100 scale in terms of safety. Sensitivities and specificities of the pH test at each cut-off were extracted from our previous research. Aggregating outcome scores and probabilities resulted in weighted scores which enabled an analysis of the relative safety of the checking procedure under various pH cut-offs.ResultsThe pH test was the safest under cut-off 5 when there was ≥30% of NG tube misplacements. Under cut-off 5, respiratory feeding was excluded; oesophageal feeding was kept to a minimum to balance the need of chest X-rays for patients with a pH higher than 5. Routine chest X-rays were less safe than the pH test while to feed all without safety checks was the most risky.DiscussionThe safety of the current checking procedure is sensitive to the choice of pH cut-offs, the impact of feeding delays, the accuracy of the pH in the oesophagus, as well as the extent of tube misplacements.ConclusionsThe pH test with 5 as the cut-off was the safest overall. It is important to understand the local clinical environment so that appropriate choice of pH cut-offs can be made to maximise safety and to minimise the use of chest X-rays.Trial registration numberISRCTN11170249; Pre-results.

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Long-Term Nasogastric Feeding Tube

JAMA ◽

10.1001/jama.1969.03160290109037 ◽

1969 ◽

Vol 210 (3) ◽

pp. 557

Author(s):

Lee R. Sataline

Keyword(s):

Feeding Tube ◽

Nasogastric Feeding ◽

Nasogastric Feeding Tube

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Esophageal Perforation with Unilateral Fluidothorax Caused by Nasogastric Tube

Case Reports in Pediatrics ◽

10.1155/2016/4103734 ◽

2016 ◽

Vol 2016 ◽

pp. 1-2

Author(s):

Lukas P. Mileder ◽

Martin Müller ◽

Friedrich Reiterer ◽

Alexander Pilhatsch ◽

Barbara Gürtl-Lackner ◽

...

Keyword(s):

Nasogastric Tube ◽

Esophageal Perforation ◽

Signs And Symptoms ◽

Feeding Tube ◽

Tube Placement ◽

Nasogastric Feeding ◽

Medical Interventions ◽

Life Saving ◽

Diagnostic Approaches ◽

Nasogastric Tube Placement

Preterm infants are highly susceptible to injuries following necessary and often life-saving medical interventions. Esophageal perforation is a rare, yet serious complication that can be caused by aerodigestive tract suction, endotracheal intubation, or nasogastric tube placement. We present the case of a neonate born at 23 weeks plus three days of gestation with chest radiography showing malposition of the nasogastric feeding tube and massive right-sided effusion of Iopamidol in the pleural cavity due to esophageal perforation. In addition, the article summarizes common signs and symptoms associated with esophageal perforation in infants and discusses diagnostic approaches.

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The endocrine effects of bitter tastant administration in the gastrointestinal system - Intragastric versus intraduodenal administration

AJP Endocrinology and Metabolism ◽

10.1152/ajpendo.00636.2020 ◽

2021 ◽

Author(s):

Wout Verbeure ◽

Eveline Deloose ◽

Joran Tóth ◽

Jens F. Rehfeld ◽

Lukas Van Oudenhove ◽

...

Keyword(s):

Feeding Tube ◽

Gut Peptides ◽

Nasogastric Feeding ◽

Physiological Relevance ◽

Quinine Hydrochloride ◽

Healthy Female ◽

Glucagon Like Peptide ◽

Glucagon Like Peptide 1 ◽

Acyl Ghrelin ◽

Intraduodenal Administration

Bitter tastants are recently introduced as potential hunger-suppressive compounds, the so-called "Bitter pill". However, the literature about bitter administration lacks consistency in methods and findings. We want to test whether hunger ratings and hormone plasma levels are affected by: 1) the site of administration: intragastrically (IG) or intraduodenally (ID), 2) the bitter tastant itself, quinine hydrochloride (QHCl) or denatonium benzoate (DB), and 3) the timing of infusion. Therefore, 14 healthy, female volunteers participated in a randomized, placebo-controlled six-visit crossover study. After an overnight fast, DB (1µmol/kg), QHCl (10µmol/kg) or placebo were given IG or ID via a nasogastric feeding tube. Blood samples were taken 10 min prior to administration and every 10 min after administration for a period of 2 hours. Hunger was rated at the same timepoints on a visual analogue scale (VAS). ID bitter administration did not affect hunger sensations, motilin or acyl-ghrelin release compared with its PLC infusion. IG QHCl infusion tended to suppress hunger increase, especially between 50-70 minutes after infusion, simultaneously with reduced motilin values. Here, acyl-ghrelin was not affected. IG DB did not affect hunger or motilin, however acyl-ghrelin levels were reduced 50-70 minutes after infusion. Plasma values of glucagon-like peptide 1 and cholecystokinin were too low to be properly detected or to have any physiological relevance. In conclusion, bitter tastants should be infused into the stomach to reduce hunger sensations and orexigenic gut peptides. QHCl has the best potential to reduce hunger sensations, and it should be infused 60 minutes before food intake.

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Unusual Gross Pneumocephalus and Pneumoperitoneum after VP Shunt Surgery: A Case Report

Journal of Neonatal Surgery ◽

10.47338/jns.v4.174 ◽

2015 ◽

Vol 4 (2) ◽

Author(s):

A Khanolkar ◽

YK Sarin

Keyword(s):

Case Report ◽

Unusual Case ◽

Shunt Surgery ◽

Vp Shunt ◽

Shunt Procedure ◽

Surgical Emphysema

We report an unusual case where a two-month infant developed a simultaneous and spontaneous pneumocephalus and gross pneumoperitoneum along with progressive surgical emphysema after VP shunt procedure.

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Bacterial contamination of nasogastric feeding tube and development of neonatal sepsis in premature newborns: a prospective observational research at a tertiary care center in Gujarat, India

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20182547 ◽

2018 ◽

Vol 5 (4) ◽

pp. 1462

Author(s):

Rekha Thaddanee ◽

Shamim Morbiwala ◽

Hasmukh Chauhan ◽

Jigar Gusani ◽

Parima Dalal

Keyword(s):

Necrotizing Enterocolitis ◽

Neonatal Sepsis ◽

Microbial Growth ◽

Tertiary Care ◽

Feeding Tube ◽

Feeding Intolerance ◽

Nasogastric Feeding ◽

Premature Newborns ◽

Nasogastric Feeding Tube ◽

Group I

Background: The objective of the present study is to observe the effect of frequency of changing nasogastric feeding tube (NG-FT) on microbial growth in relation to development of neonatal sepsis in premature newborns. The study is prospective observational study in its nature. Neonatal intensive care unit (NICU) of a tertiary care teaching hospital of western Gujarat, India, from December 2016 to November 2017.Methods: Eighty-five preterm newborns admitted to NICU for feeding support were randomly divided into three groups depending on frequency of changing nasogastric feeding tubes (Group I, II and III with NG-FT changed every 12, 24 and 48 hourly respectively). In Groups I, II and III, the first NG-FT cultures were sent at the end of 12, 24, 48 hours of NG-FT insertion respectively. The second and third NG-FT cultures were sent after 7 and 14 days respectively. Microbial growth pattern was observed and correlated with development of necrotizing enterocolitis (NEC), neonatal sepsis and mortality.Results: Microbial growth on first NG-FT culture significantly increased when frequency of changing nasogastric feeding tube was reduced from every 12 to 24 or 48 hours {p = 0.0432 (Group I vs II) and 0.0001 (Group I vs III)}. Microbial growth increased on second (24.1%, 87% and 85% in groups I, II and III respectively) and third NG-FT culture (44% in group I and 100% in groups II and III); this was significantly high in group II and III as compared to group I (p = 0.0001). Common organisms isolated were Klebsiella pneumonia (63.28%), Pseudomonas aeruginosa (32%) and Escherichia coli (21%). No significant difference was noted in incidences of feeding intolerance, necrotizing enterocolitis (NEC), neonatal sepsis and mortality among the three groups.Conclusions: Organism growth in nasogastric feeding tube culture increases significantly when frequency of changing NG-FT is beyond 12 hours. However, there is no increase in episodes of feeding intolerance, necrotizing enterocolitis (NEC), neonatal sepsis and mortality.

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Nutrothorax complicating a misplaced nasogastric feeding tube in a severely ill patient

Autopsy and Case Reports ◽

10.4322/acr.2012.003 ◽

2012 ◽

Vol 2 (1) ◽

pp. 19-24

Author(s):

Aloísio Felipe-Silva ◽

Fernando Peixoto Ferraz de Campos

Keyword(s):

Feeding Tube ◽

Nasogastric Feeding ◽

Nasogastric Feeding Tube

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Risk Score for Predicting Dysphagia in Patients After Neurosurgery: A Prospective Observational Trial

Frontiers in Neurology ◽

10.3389/fneur.2021.605687 ◽

2021 ◽

Vol 12 ◽

Author(s):

Li Zeng ◽

Yu Song ◽

Yan Dong ◽

Qian Wu ◽

Lu Zhang ◽

...

Keyword(s):

Tracheal Intubation ◽

Characteristic Curve ◽

Feeding Tube ◽

Apache Ii ◽

Selection Strategy ◽

Nasogastric Feeding ◽

Nasogastric Feeding Tube ◽

Multicenter Prospective Observational Study ◽

Validation Set ◽

Risk Predictors

Background: Acquired dysphagia is common in patients with tracheal intubation and neurological disease, leading to increased mortality. This study aimed to ascertain the risk factors and develop a prediction model for acquired dysphagia in patients after neurosurgery.Methods: A multicenter prospective observational study was performed on 293 patients who underwent neurosurgery. A standardized swallowing assessment was performed bedside within 24 h of extubation, and logistic regression analysis with a best subset selection strategy was performed to select predictors. A nomogram model was then established and verified.Results: The incidence of acquired dysphagia in our study was 23.2% (68/293). Among the variables, days of neurointensive care unit (NICU) stay [odds ratio (OR), 1.433; 95% confidence interval (CI), 1.141–1.882; P = 0.005], tracheal intubation duration (OR, 1.021; CI, 1.001–1.062; P = 0.175), use of a nasogastric feeding tube (OR, 9.131; CI, 1.364–62.289; P = 0.021), and Acute Physiology and Chronic Health Evaluation (APACHE)-II C score (OR, 1.709; CI, 1.421–2.148; P < 0.001) were selected as risk predictors for dysphagia and included in the nomogram model. The area under the receiver operating characteristic curve was 0.980 (CI, 0.965–0.996) in the training set and 0.971 (0.937–1) in the validation set, with Brier scores of 0.045 and 0.056, respectively.Conclusion: Patients who stay longer in the NICU, have a longer duration of tracheal intubation, require a nasogastric feeding tube, and have higher APACHE-II C scores after neurosurgery are likely to develop dysphagia. This developed model is a convenient and efficient tool for predicting the development of dysphagia.

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