Nasal feeding tubes for SMA

Overview
Nasal feeding tubes are temporary, non-surgical tubes placed through the nose and into the stomach or intestine. They provide short-term nutrition for people with spinal muscular atrophy (SMA) who have difficulty eating.

A feeding tube is typically recommended for people with SMA who develop impaired swallowing - which can cause inhalation of food and liquids into the lungs - or those having trouble consuming enough foods or liquids to meet their nutritional needs.

A nasal tube is often the first tube a person with SMA may receive for food and medication supplementation. It may be a “trial run” prior to placing a more permanent, surgical solution such as a gastronomy tube (G tube).

Nasal tubes are one type of feeding support for people SMA. Other options include a gastronomy or G-tube, as well as G-tube with Nissen fundoplication (known as a stomach wrap).

What does it involve?
There are three types of nasal tubes: Nasogastric (NG), nasoduodenal (ND), and nasojejunal (NJ). The choice of tube depends on whether or not an individual can tolerate feeding into the stomach.

NG-tubes enter the body through the nose and run down the esophagus into the stomach. ND-tubes are similar to NG-tubes, except they end in the first portion of the small intestine, the duodenum. NJ-tubes extend even further to the second portion of the small intestine, the jejunum. Bypassing the stomach can be beneficial for people whose stomachs don’t empty well, have chronic vomiting, or aspirate stomach contents into the lungs.

A nasal tube is initially inserted by a doctor or nurse. The medical professional will train the person with SMA or their parents how to insert the tube at home.

Depending on the individual’s needs, a dietician will determine type and amount of nutritional formula, and length of feeding time. Feedings through nasal tubes are generally done with either a gravity drip, syringe or feeding pump. NJ tube feedings can only be done with a pump.

Intended Outcome
The goal of NG tubes is to provide supplemental food and medicine to the stomach or small intestine through the nose. It can be used to provide extra calories when an individual is unable to eat by mouth, struggling with digestion, or going through an illness.

Results
More research is needed to determine the nutritional outcomes of nasal tubes for people with SMA.

Because SMA nutritional problems can also affect a person’s breathing and general well-being, researchers recommend involving a team of physicians, speech therapists or occupational therapists, dietitians, and pediatric surgeons to optimize survival and quality of life.

Constraints
Any surgery carries risks including blood clots, blood loss, infection, breathing problems, reactions to medication, and heart attack or stroke during the surgery.

The process of placing a nasal tube is very low risk. Common complications of living with a nasal tube, however, include gastrointestinal issues such as diarrhea, constipation or vomiting, food aspiration/reflux and gagging, tube-site infection, and pneumonia. Nasal tubes can also become clogged or dislodged.

Increased nasal congestion is possible, especially in infants. Using both a nasal tube and non-invasive ventilation, such as a bilevel positive airway pressure (BiPAP), may create mask fit issues and discomfort.

Because nasal tubes can be uncomfortable, small children will pull them out. Taping the tube to a child’s face, or down the back of a child’s shirt day or can prevent removal and keep it from tangling.

For more details, visit:
1. Understanding Spinal Muscular Atrophy (SMA) 一 Cure SMA
2. Nasal Tubes - Feeding Tube Awareness Foundation
3. Nasogastric Tube Feeding 一 Children’s Minnesota
4. Nasojejunal Tube Feeding Using a Feeding Pump 一 Cincinnati Children’s
5. Consensus Statement for Standard of Care in Spinal Muscular Atrophy 一 Journal of Child Neurology
6. Gastroenteric tube feeding: Techniques, problems and solutions 一 World Journal of Gastroenterology