NASOGASTRI

C FEEDING
FOR
NEONATES
(GAVAGE
FEEDING)
Feeding and
Nutrition
Nutritional requirements may increase
while infant or child is ill but the ability
to feed naturally may be impaired by
illness or the child’s response to illness.
If existing feeding patterns cannot be
maintained alternate methods may be
necessary.
 NGT/GAVAGE FEEDING
1. NGT/Gavage feeding is a means of
providing food by way of a catheter passed
through the nares or mouth, past the pharynx,
down the esophagus and into the stomach
slightly beyond the cardiac sphincter.
Feedings may be continuous or intermittent.
2. Gavage feeding can provide a method of
feeding or administering medications that
require minimal patient effort when the
child is unable to suck or swallow
adequately (e.g. premature neonates under
32 weeks gestation or under 1, 560 g;
children with neurologic deficits or
respiratory compromise
 3. Gavage feedings provide a
route that allows adequate
calorie or fluid intake; they can
also provide supplemental or
additional calories.
4. Gavage feedings can prevent
fatigue or cyanosis that is apt to
occur from bottle-feeding.
They can provide supplements
for an infant who is a poor
bottle-feeder.
 5. Gavage feedings can provide a safe
method of feeding hypotonic patients,
patients experiencing respiratory distress
(respiratory rate greater than 60/min),
patients with uncoordinated suck &
swallow, intubated patients, debilitated
patients & patients with anomalies in the
digestive tract
Gavage (guh-vahj) feeding is a way to
provide breastmilk or formula directly
to a baby’s stomach. A tube placed
through the baby’s nose (called a
Nasogastric or NG tube) carries breast
milk/formula to the stomach.
 Why does my baby need gavage
feeding?

Babies who are premature and too

small or weak to suck enough from
the breast or bottle.
 • Babies who have a problem
coordinating their suck and
swallow.

• Babies who have a problem

with their throat, esophagus, or
bowel.
• Babies, who may have
lung and heart
problems, are breathing
too hard or too fast to
be able to suck and
swallow.
NGT INSERTION
What equipment is needed?
• Appropriate size feeding tube
• Small syringe (3cc) for checking
stomach contents and injecting air
• Large syringe for breast milk or
formula (60cc)
 • Stethoscope
• Tape
• A cup of water or water soluble
lubricating jelly (do not use
petroleum jelly because this will
clog
the tube)
• A blanket for swaddling your
baby
NGT FEEDING
MATERIALS
You Have To Prepare All The Materials, Formula, Medicines, Fluid/Water At The
Preparation Area Of The Nurses’ Station Before Going To The Patient
- Wash hands before preparing all the materials, formula, medicines, water
- Wash hands after preparing everything
CHECKLIST
1. Explain procedure
to parents and gain
informed consent.
2. Begin by washing your
hands
3. Put protective towel or
napkin over the neonate's
chest.
4. The feeding position should be right side lying, with head and
chest slightly elevated.
 Right-side Lying Position
Rationale: This position allows the flow
of fluids aided by gravity.
5. Aspirate the tube before
feeding.
This begins to assess for
residual contents and to
remove any air.
 Aspirating
Rationale: This is done to monitor for
appropriate fluid intake, digestion time
or overfeeding that can cause
distention,
a. If over one-half of the previous
feeding is obtained by aspiration,
withhold the next feeding. Do not
return aspirate to the stomach.
Notify the health care provider of
the large residual volume.
 b. If a small residual of formula is
obtained, return it to the stomach
and subtract that amount from the
total amount of formula to be given.
Document any residual contents.
 6. Attach the reservoir to catheter and fill with feeding.
Encourage the infant to suck on a pacifier during the feeding.
Hold the infant when possible.
Rationale: The use of the pacifier will relax the infant, allowing
for easier flow of fluids as well as provide for normal sucking
needs.
7. The flow of the feeding should be
slow. Do not apply pressure. Elevate
the reservoir 6-8 inches (15-20 cm)
above the patient's head.
 The rate of flow
Rationale: The rate of flow is controlled by the size of the catheter; the smaller the size, the slower the
flow. If the reservoir is too high, the pressure of the fluid itself increases the rate of flow
 a. Feedings given too rapidly may
interfere with peristalsis, causing
abdominal distention, regurgitation
and possibly, emesis.
b. Feeding time should last
approximately as long as 5
ml/5-10 minutes or 15-20
minutes total time.
8. When the feeding is completed, the catheter may be irrigated with
clear water. Before the fluid reaches the end of the catheter, clamp it
off and withdraw it quickly or keep in place for the next feeding.
 Rationale:
Clamping the catheter before air enters the stomach prevents abdominal distention.
Clamping also prevents dripping of fluids from the catheter to the pharynx
causing the patient to gag and aspirate.
9. Discard the feeding tube and
any leftover solution.
10. Burp the patient. (The patient
may not burp if air was aspirated
from the tube following the
feeding.)
 Rationale:
Adequate expulsion of air swallowed or ingested during the feeding will decrease
abdominal distention and allow for better tolerance of the feeding.
 11. Place the patient on his
right side for at least 1 hour.
 Rationale:
To facilitate gastric emptying and minimize regurgitation and
aspiration.
12. Observe the patient's condition
after feeding; bradycardia and
apnea may still occur.
 Rationale:
Because of vagal stimulation
13. Note vomiting or abdominal
distention.
 Rationale:
Due to overfeeding or too rapid feeding.
Regurgitation of 1-2 ml may occur in the premature infant as the musculature of the
sphincter of the GI tract is relaxed and allows for easy reflex.
 14. Accurately describe and record
procedure, including time of
feeding, type of gavage tube
feeding, type and amount of feeding
fluid given, amount retained or
vomited, how the patient tolerated
feeding and activity before, during
and after feeding.
 Rationale:
Observe for the readiness of the infant to feed by nipple- note sucking activity and sleep
wake cycle in relation to feeding