Different hospitals have different practices and there's not much research to support either option. I personally will not do a feeding evaluation on an infant w/ an OG tube in place. It is so disruptive to the suck-swallow for MOST babies. If a baby is ready to start/trial oral feeds nursing will remove the tube & generally can place an NG tube even if baby is on nasal cannula. 

Can you imagine trying to drink or suck from a straw or sports bottle with an OG tube in place, running along your tongue, humping up & hitting your velum & posterior pharyngeal wall (possibly triggering a gag) every time you tried to swallow? Our hospital actually had a policy that we would not do swallow studies on adults with OG tubes in place because it was so disruptive to the swallow that it skewed our results. I realize that we can't necessarily generalize adult swallowing to infants though.

Some hospitals actually remove NG and OG tubes *after every feeding* so they are not indwelling at all. If insertion & removal is done properly it is thought to be less traumatizing & invasive than having an indwelling tube that is keeping sphincters open (potentially contributing to reflux) & physically present & moving for every suck & swallow the baby does. The last that I read up on this (at least three years ago) there was some research to support indwelling tubes (the idea that insertion & removal was the traumatizing/difficult part) & some research to support removing tubes after every feed & re-inserting. The key with removal & re-insertion was careful training of the nursing staff on optimal methods (I believe the method that caused the fewest overt stress signs in infants was actually a very slow, cautious method of insertion vs. getting it in as quickly as possible). Erin Ross is a NICU speech pathologist & has worked in units where both of these methods are practiced & she says she sees pros & cons to each.

So if your neos (or nurses) are not on board for moving an OG tube to NG, my personal bias is that I would remove for every oral feed OR just wait to start oral feeds. This was my practice, but it was almost never an issue as nursing was typically happy to move the tube. And I was working with both breastfeeding and bottle feeding. Another thought, if their respiration is not stable enough for them to tolerate an NG tube taking up part of one nares, is it possible they are not really ready for oral feeds?

Hope that was helpful.

Laura Wasielewski MS, CCC-SLP, IBCLC
Los Angeles, CA

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