POCUS-guided nasojejunal tube placement reduces malposition and radiation exposure in neonates: a multicenter real-world retrospective study.

backgroundBlind nasojejunal tube (NJT) insertion with radiographic confirmation often results in initial malposition and repeated imaging in neonates, raising concerns about procedural delays and cumulative radiation. Point-of-care ultrasound (POCUS) enables real-time, radiation-free guidance, but multicenter neonatal evidence has been limited.

methodsWe conducted a multicenter, real-world retrospective cohort study across three tertiary NICUs in China (May 2023-May 2025). Neonates requiring postpyloric feeding were managed with either POCUS-guided insertion with bedside sonographic confirmation or conventional insertion with post-procedural radiography, according to the insertion pathway used in routine clinical practice. The primary outcome was first-pass success (correct jejunal position on the initial attempt). Secondary outcomes included total insertion attempts, technical insertion time, number of radiographs, time to initiation of postpyloric feeding, final placement success by the end of the episode, and procedure- or dwell-related adverse events.

resultsForty-six neonates were analyzed (POCUS, n = 24; radiography, n = 22) with comparable baseline characteristics. POCUS achieved higher first-pass success (87.5% vs 36.4%; odds ratio [OR] 12.25; 95% CI 2.76-54.32; P < 0.001), fewer insertion attempts (median 1 vs 2; P < 0.001), and shorter technical insertion time (median 7 vs 19 min; P < 0.001). Radiographic exposure was markedly reduced (median films 0 vs 2; P < 0.001), and time to initiation of postpyloric feeding was earlier (median 0.92 vs 5.14 h; P < 0.001). Final jejunal placement success by the end of the episode was 100.0% vs 81.8% (P = 0.045). No insertion-related cardiorespiratory events occurred in either group; dwell-related complications were 0.0% vs 13.6% (P = 0.101). Adjusted analyses were directionally consistent.

conclusionsIn this multicenter neonatal cohort, POCUS-guided NJT placement substantially improved first-attempt success and procedural efficiency while minimizing radiographic exposure and expediting postpyloric feeding, without increasing adverse events. These real-world data support POCUS-guided NJT placement as a promising radiation-sparing bedside strategy in trained NICUs and warrant prospective validation. IMPACT: POCUS-guided nasojejunal tube placement improved first-pass success in neonates requiring postpyloric enteral feeding. POCUS guidance reduced insertion attempts, shortened technical insertion time, and expedited initiation of postpyloric feeding. A POCUS-first strategy markedly reduced radiographic exposure compared with conventional radiography-confirmed placement. This multicenter real-world study supports POCUS-guided neonatal enteral access as a promising radiation-sparing bedside strategy in trained NICUs. Prospective studies are warranted to validate this approach and define standardized training and quality-assurance requirements.