NASOINTESTINAL TUBE STUDY IN YOUNG CHILDREN

这个子项目是利用由NIH/NCRR资助的中心拨款提供的资源的许多研究子项目之一。子项目和调查员(PI)可能从另一个NIH来源获得了主要资金，因此可能会出现在其他CRISE条目中。列出的机构是针对中心的，而不一定是针对调查员的机构。当胃肠系统功能正常，胃喂养被确定为不安全时，许多儿童首选鼻肠(NI)管喂养，预计短期内需要辅助喂养。无论放置NI管的方法如何，在开始喂养之前，通常都会获得X光片，以确保管的位置正确。随后，不对NI管的放置进行常规检查。NI管的远端尖端可以从十二指肠向上移动到胃甚至食道，即使管的外部部分仍然固定在适当的位置。当出现呕吐、剧烈咳嗽或鼻气管抽吸时，这种情况尤其可能发生。当管子不到位时，儿童可能会受到严重伤害，导致发病率增加。在这一人群中增加NI管喂养的安全性需要两个方面的知识发展--预测正确的管放置的插入距离和保持正确的管位置。这项初步研究与第二种知识需求有关。样本将包括50名19岁的住院儿童，他们已经安装了NI管。将测量导管吸出物的pH值和胆红素水平，以检测胃或肠道的位置。实际的导管位置将由腹部X线片确定，以评估放置定位方法的充分性。其目的是获得移位患病率的初步估计，以及放置定位方法的敏感性、特异性、阳性和阴性预测值，以确定未来多中心研究所需的样本量。长期目标是找到确定儿童NI管内部位置的最佳临床方法(S)。

This subproject is one of many research subprojects utilizing the resources provided by a Center grant funded by NIH/NCRR. The subproject and investigator (PI) may have received primary funding from another NIH source, and thus could be represented in other CRISP entries. The institution listed is for the Center, which is not necessarily the institution for the investigator. Feeding by nasointestinal (NI) tube is preferred for many children when the gastrointestinal system is functional, gastric feeding has been determined to be unsafe, and the need for assisted feeding is expected to be short-term. Regardless of the method used to place NI tubes, radiographs are routinely obtained to assure correct tube position prior to initiation of feedings. Subsequently, placement of NI tubes is not routinely checked. An NI tube's distal tip can shift upward from the duodenum into the stomach or even the esophagus, even when the external portion of the tube remains taped in place. This is especially likely when vomiting, severe coughing, or nasotracheal suctioning occurs. When tubes are out of place, children can be seriously harmed, causing increased morbidity. Increasing the safety of NI tube feeding in this population requires knowledge development in two areas-predicting the insertion distance for correct tube placement and maintaining correct tube positioning. This preliminary study is relevant to the second of these knowledge needs. The sample will consist of 50 hospitalized children < 19 years of age having an NI tube already in place. The pH and bilirubin levels of tube aspirate will be measured to detect gastric or intestinal location. Actual tube location will then be determined by abdominal radiograph to assess the adequacy of the placement-locating methods. The goal is to obtain initial estimates of prevalence of displacement, and sensitivity, specificity, positive and negative predictive value of the placement-locating methods to determine sample sizes needed in a future multi-center study. The long-term goal is to find the best clinical method(s) of determining the internal location of NI tubes in children.