Effectiveness of nasogastric versus orogastric tube feeding in preterm infants: A systematic review and meta-analysis

Objectives: This systematic review and meta-analysis evaluated the effectiveness of nasogastric versus orogastric tube feeding on feeding performance in preterm neonates. Methods: Randomized, quasi-randomized, and cross-over trials published in peer-reviewed journals with no language or country restrictions were included. Preterm neonates (<37 weeks) receiving nasogastric or orogastric enteral feeding until full oral feeds were established formed the exposure and comparison groups. Primary outcome: time to achieve full enteral feeding; secondary outcomes: feeding performance, growth, and adverse events. A comprehensive literature search across multiple databases was conducted up to January 2024. Two authors independently screened studies, assessed the risk of bias, and performed a meta-analysis using a random effects model. Evidence levels were determined following Grades of Recommendation, Assessment, Development, and Evaluation guidelines. Results: Six studies, including 273 preterm neonates, were included. Nasogastric feeding reduced the time to achieve full enteral feeds compared to orogastric feeding (mean difference [MD], −1.62 days; 95% confidence interval [CI], −2.25 to −0.99 days) with very low certainty of evidence. Combined episodes of bradycardia and desaturation per hour were higher in nasogastric feeding than orogastric feeding (MD, 0.24; 95% CI, 0.14–0.34), as were episodes of bradycardia (MD, 0.08; 95% CI, 0.04–0.13) and desaturation (MD, 0.16; 95% CI, 0.10–0.22). No significant differences were found in time to regain birth weight, apnea, necrotizing enterocolitis, or sepsis. Conclusions: Nasogastric tube feeding reduces the time to achieve full enteral feeds but increases episodes of bradycardia and desaturation compared to orogastric feeding in preterm neonates. Cautious interpretation is required as the low to very low certainty evidence highlights the need for larger, well-designed trials for evidence-based recommendations.