We thank the authors of the Letter to the Editor for their thoughtful comments regarding standardization of feeding tube care in neonates using the "nose-ear-midway to the umbilicus" (NEMU) method for insertion length determination and pH analysis to verify gastric placement. The goal of our recently published article was not to recommend practice guidelines but to (1) critically review available evidence supporting methods to determine insertion lengths and verify gastric placement of feeding tubes in critically ill infants; (2) provide information regarding methods used by neonatal nurses to determine insertion length and verify gastric placement of feeding tubes; and (3) demonstrate discrepancies between procedures supported by existing research and clinical nursing practice. Our findings illustrate inconsistency between nursing practice and evidence-based methods and thus support the need for standardizing methods for both feeding tube insertion depth determination and gastric placement verification. Practice standards would increase the likelihood of nurses utilizing the most reliable available methods, thus potentially improving patient care. However, our findings also emphasize the critical need for well-designed research to provide more robust evidence to support recommended methods.

Sincerely,

Leslie A. Parker, PhD, APRN, FAAN

Associate Professor, University of Florida College of Nursing Gainesville

Jessica H. Withers, MSN, RN, RNC-NIC

Nurse Coordinator, UF Health Shands Hospital

Elizabeth Talaga, MSN, ARNP, RNC-NIC

Nurse Manager, Neonatal ICU, UF Health Shands Children's Hospital