PM1054: Nasojejunal and Gastrojejunal Feeding Tubes Are Associated with Significant Radiation Exposure in Infants

Background: Nasojejunal (NJ) feedings are used in infants unable to tolerate gastric feeding or at high risk of aspiration. We aimed to determine the procedural burden, clinical course, and 1-year outcomes of infants with NJ tubes.

Methods: A retrospective chart review was performed for all infants 1 year of age and under receiving a nasojejunal feeding tube at a single tertiary care pediatric hospital from 2016-2020. Demographics, clinical, and procedural data were collected. Specifically, alternate feeding strategies within 1 year of initial NJ tube placement, including gastrostomy, gastrojejunostomy, and Nissen fundoplication were sought. Descriptive statistics were used to describe the study population; medians and interquartile ranges were reported.

Results: Over the 5-year study period, 122 infants 1 year of age and under received an NJ tube for enteral feeding access. Fifty two percent were female with a median birth weight of 2.7 kg [2.2-3.3], weight percentile of 31 [5-66], and z-score of -0.45 [-1.7-0.4]. Infants received their first NJ tube at a median of 5.3 months [3.2-8.3], weight of 5.7 kg [4.1-7.5], weight percentile of 6 [1-36], and z-score of -1.6 [-2.6 - -0.4]. A total of 415 NJ tubes were placed. The median number of NJ tube placements per patient was 2 [1-5] with a median radiation exposure of 6.4mGy [4.4-10] per placement. Infants required hospital admission for 13% of placements and general anesthesia for 23% of placements. Two patients experienced complications from the NJ tube within 1 year of initial placement – 1 intussusception and 1 perforation. At 1 year following initial NJ tube placement, 77% of patients were alive with a median of 9.8 kg [8.8-11.0], weight percentile of 35 [10.0-63.0], and z-score of -0.46 [-1.3-0.3]; 50% remained on full/partial tube feeds. Of the patients alive at 1 year after initial NJ placement, 72% required an alternate surgical feeding strategy (gastrostomy, gastrojejunostomy). Table 1 compares the outcomes of different surgical feeding strategies.

Conclusion: Infants with nasojejunal feeding tubes are exposed to significant radiation exposure, with the majority undergoing an alternate surgical feeding strategy 1 year following initial placement. The gastrojejunal strategy is associated with 4 times greater radiation exposure than G-tubes and Nissen fundoplication. All three feeding strategies result in similar weight increases, while Nissen fundoplication demonstrates a trend towards increased likelihood of oral feedings. In infants requiring a long-term feeding strategy, consideration should be given to G-tubes and fundoplication to minimize radiation exposure.