Malposition of a nasogastric tube into the middle ear of a premature one week old infant
Bibliographic record
Abstract
A significant number of pediatric patients require a nasogastric tube (NGT) during their hospital stay for indications including nutrition support, medication delivery and decompression of the gastrointestinal tract. As such NGT placement is commonly performed; however, misplacement can occur into other anatomic sites within proximity.Primary DiagnosisWe report a first in the literature case of NGT misplacement into the middle ear via the eustachian tube in a one-week-old premature infant that required an NGT for feeding support.Clinical FindingsThere was no reported resistance or concerns during NGT insertion; however, blood was noted in the syringe during aspiration performed to confirm tube position. A plain film radiograph and thereafter high-resolution computed tomography (HRCT) imagining confirmed the malposition of the tube within the middle ear.Interventions and OutcomesAfter transfer to a tertiary center, the NGT was removed without event in the neonatal intensive care unit (NICU) under direct vision with a flexible nasal endoscopy and successful replacement occurred thereafter. No injury to the middle ear structures or hearing occurred.Practice RecommendationsWhile not a common site of misplacement, nasogastric tubes can be misdirected via the eustachian tube into the middle ear. Imaging modalities such as plain film radiographs and computed tomography can be helpful when misplacement is suspected based on bedside assessment. Protocols for routine replacement of functional nasogastric tubes after specific time periods in an effort to prevent nasal alar or nasal cavity complications from pressure should consider the risk of misplacement and consequences thereof.
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How this classification was reachedexpand
Full frame distilled prediction
Teacher imitationNot calibrated prevalence, not ground truth. Human validation pending. Learned from the 10,348 direct Codex labels and 10,348 direct Gemma labels. Candidate is the union of thresholded teacher heads; consensus is their intersection. These outputs are machine_predicted_unvalidated and are not human labels or direct frontier model labels.
Codex and Gemma teacher scores by category
| Category | Codex | Gemma |
|---|---|---|
| Metaresearch | 0.001 | 0.001 |
| Meta-epidemiology (narrow) | 0.000 | 0.000 |
| Meta-epidemiology (broad) | 0.001 | 0.000 |
| Bibliometrics | 0.001 | 0.001 |
| Science and technology studies | 0.000 | 0.000 |
| Scholarly communication | 0.000 | 0.000 |
| Open science | 0.000 | 0.000 |
| Research integrity | 0.000 | 0.000 |
| Insufficient payload (model declined to judge) | 0.001 | 0.000 |
Machine scores (provisional)
The two teacher heads of the student model, read on this work. A score orders the frame for review; it never asserts a category, and the validation status ships verbatim with every row.
Baseline scores from an immature model (maturity gate not passed, 7 training rounds). Scores rank; they never assert a category.
score_only:v0-immature-baseline · verbatim from the scoring run: score_only means the number may rank works, and no category label ships from itClassification
machine, unvalidatedMachine predicted; a candidate call from one teacher head, not a consensus.
How this classification was reached, model by model and score by score, is at the end of the page under "How this classification was reached".