#2-Rare Fatal Complication in Kitten Highlights Risks of Nasogastric Tubes in Neonates

Inadvertent Intracranial Nasogastric Tube Placement Causing Traumatic Brain Injury in a Neonatal Cat

Riley Shugg, Steven W. Frederick, Sarah A. Moore, Lisa L. Powell

Background

While nasogastric feeding tubes are commonly used for neonatal nutritional support in veterinary medicine, complications—although typically involving the respiratory tract—can also involve the central nervous system. Intracranial nasogastric tube placement through the cribriform plate is a documented but exceedingly rare complication in human medicine. This case report is the first to describe such an event in a veterinary patient, specifically a neonatal kitten, with fatal consequences.

Methods

A 20-day-old domestic shorthair kitten was presented for labored breathing and anorexia, diagnosed with bronchointerstitial pneumonia. Initial nasogastric feeding was successful, but re-placement of the tube the following day resulted in suspected intracranial misplacement. Radiographs, postmortem MRI, and necropsy were used to confirm the diagnosis and characterize the traumatic injury.

Results

Initial placement of the nasogastric tube was uneventful, but re-insertion encountered mild resistance. Subsequent radiographs showed the tube coiled intracranially via the cribriform plate. Despite immediate removal and supportive care, the kitten developed worsening respiratory signs and neurologic deficits. Postmortem MRI revealed hemorrhagic tracts in both cerebral hemispheres and the cerebellum. Necropsy confirmed multifocal to locally extensive brain hemorrhage and pneumonia with viral inclusion bodies (suspected feline herpesvirus). The presumed cause of death was respiratory failure, though traumatic brain injury may have contributed.

Limitations

No orthogonal radiographic view was obtained at the time of tube misplacement to confirm intracranial placement; the diagnosis relied on lateral radiographs and postmortem imaging. Fluid drainage from the nares was not analyzed to confirm cerebrospinal fluid, leaving some ambiguity regarding secondary complications like CSF rhinorrhea.

Conclusions

This case underscores a rare but severe risk associated with nasogastric tube placement in neonatal veterinary patients. Altered anatomy or small size in neonates may increase the risk of tube misdirection through the cribriform plate. Standard radiographic confirmation protocols may be insufficient, and additional views or advanced imaging should be considered, particularly when resistance is encountered during placement. This case highlights the need for heightened awareness and refined placement protocols to avoid potentially fatal iatrogenic brain trauma.

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