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Gavage Feeding

Provide gavage feeding to a baby who is less than 32 weeks gestation age (< 1200 g), or 32 - 34 weeks gestation age (1200 - 1500 g) during initial stabilization or any age baby having uncoordinated suck and swallow because of altered sensorium, on discretion of treating doctor. When a baby is on calculated volume of gavage feeding/NBM and shows signs of hunger (crying is a late sign), baby should be fed after immediate consultation with doctor on duty.

PROCEDURE​

Before gavage feeding a baby, always assess abdominal girth. Digestion is assessed by abdominal girth. If the abdominal girth has increased or if the stomach is hard to palpate, contact the doctor before gavage feed.

  • Wash hands and dry.
  • Make sure the tube is properly secured and visually correctly positioned.
  • The infant should be monitored for any evidence of feed intolerance including abdominal girth, gastric residues or clinical signs of NEC. If the abdominal girth has increased by 2 cm, gastric residual volume should be checked. Feeding should be stopped in the presence of significant aspirate (> 25% of feed) and/ or bilious or blood stained residue.
  • Connect a new 10 or 20 ml syringe to the tube and fill the syringe with milk.
  • Allow the milk to run in slowly by gravity. The higher the syringe is held, the faster the milk will flow.
  • Babies that are awake and showing signs of hunger should be offered non-nutritive sucking in the form of breastfeeding or milk in the mouth while gavage feeding is being done. This will give for comfort, training, developmental supportive care and better oral care.
warning

Avoid pushing the milk in syringe with plunger or hand

  • Gavage feeding should normally take approximately 20-30 minutes. Attendants should be taught how to hold the syringe while feeding, so they can be included in the care of the child.
  • Do not leave the baby unattended during the feed.
  • Close the cap of the tube after feeding is finished.

If baby gets cyanotic or have fall in saturation and heart rate or have apnea, stop feeding immediately. Inform doctor on call before feeding continues.

Syringes are for one time use only. Discard syringe after each feed.

References​

  • Neonatal Intensive Care by Merenstein and Gardner, 7th edition (2011)
  • Comprehensive Neonatal Nursing Care by Kenner and Lott (2014)
  • Practical Procedures for the Newborn Nursery. Deorari, Paul, Singhal, Scotland and McMillan
  • Oslo University Hospital Procedure on Insertion of a Nasogastric Tube (2013)

Document Information​

Current Version

Version: 2.0
Published: August 20, 2015
Revised by: Dr Chetan Meena
Contributors: Nurse Meena Nair and Nurse Helene Bjornstad
Previous Versions: v1.0