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Our data demonstrate improved bar stability with no reoperative intervention when pectus excavatum is initially repaired with two Nuss bars. Primary placement of two bars has now become standard practice in our institution for correction of pectus excavatum by the Nuss procedure and would be our recommendation for consideration by other centers.

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Introduction A trend of dislodged nasogastric tubes was noted in children at a high risk for loss of enteral feeding access. There is known morbidity associated with early nasogastric tube dislodgement. Despite nursing and family education regarding the importance of these surgically placed tubes, the optimal method of securing nasogastric tubes is undetermined. Methods A nasal bridling program was implemented from February 2015 to February 2017 for pediatric surgical patients less than 1 year old requiring nasoenteric feeding tubes. The pediatric surgical service oversaw education and implementation of the program. Retrospective data collection was performed. Variables included weight and age at the time of tube placement, indications, method of placement, bridle duration, associated complications, unintended dislodgement, and diagnosis outcomes. Results Fourteen bridle systems were placed in 12 children with diagnoses including tracheoesophageal fistula, congenital diaphragmatic hernia, congenital heart disease with poor oral skills/feeding, and duodenal atresia and stenosis for 444 patient days. The average duration of bridling was 31.7 days per patient. Of the 14 bridles placed, only one unintended tube removal occurred. Discussion Bridling of nasoenteric feeding tubes is a safe and effective method for preventing unintended tube dislodgement, leading to improved patient care in the pediatric surgical population less than 1 year old. On the basis of our institution's results, ongoing continuing education for use and care of nasoenteric feeding tubes is recommended for the pediatric surgical population.