Preemptive Gastrostomy Tube Placement after Norwood Operation

• Published in: The Journal of pediatrics Vol. 159; no. 4; pp. 602 - 607.e1
• Main Authors: Garcia, Xiomara, MD, Jaquiss, Robert D.B., MD, Imamura, Michiaki, MD, PhD, Swearingen, Christopher J., PhD, Dassinger, Melvin S., MD, Sachdeva, Ritu, MD
• Format: Journal Article
• Language: English
• Published: Maryland Heights, MO Mosby, Inc 01.10.2011; Elsevier
• Subjects: Biological and medical sciences; demographic statistics; Female; Fundoplication; gastrointestinal system; Gastrostomy; General aspects; Humans; Hypoplastic Left Heart Syndrome - mortality; Hypoplastic Left Heart Syndrome - surgery; Infant, Newborn - growth & development; Laparoscopy; Laparotomy; Length of Stay - statistics & numerical data; Male; Medical sciences; mortality; neonates; Norwood Procedures; patients; Pediatrics; Postoperative Complications - prevention & control; Preoperative Care; Prevention and actions; Public health. Hygiene; Public health. Hygiene-occupational medicine; Retrospective Studies; Weight Gain; ECMO; Extracorporeal membrane oxygenation; GJ; Hypoplastic left heart syndrome; Gastrojejunostomy; UGI; Nasogastric tube; Upper gastrointenstinal; Gastrostomy tube; NG; GT; HLHS; Gastrostomy; Prevention; Stomach; Pediatrics; Treatment; Tube; Digestive system; Surgery; Operation
• ISSN: 0022-3476; 1097-6833
• DOI: 10.1016/j.jpeds.2011.04.009

Objective Because infants undergoing a Norwood operation have poor interstage weight gain, we hypothesized that preemptive gastrostomy tube (GT) placement would result in earlier discharge, improved growth, and higher survival to stage 2. Study design Records of 74 neonates who underwent a Norwood operation were reviewed until stage 2 palliation. The patients were divided into conventional (n = 43) and preemptive GT groups (n = 31). Data included demographics, cardiac surgery, feeding strategy, length of hospitalization, and mortality. Results Transplant-free survival to stage 2 was significantly higher in the preemptive group, but there were no significant differences in survival to discharge after stage 1, length of hospitalization, and weight-for-age z-score at discharge and at stage 2 palliation. In the conventional group, 27 of 43 underwent GT placement, all via laparotomy, 23 with Nissen fundoplication. In the preemptive group, all underwent GT placement (21 laparoscopic, 10 laparotomy), 7 with Nissen fundoplication. A second gastric intervention was performed in 11 of 21 with laparoscopic GT (7 conversion to gastrojejunostomy tube, 4 Nissen fundoplication). Conclusion Preemptive GT placement is associated with improved survival to stage 2 after a Norwood operation but not with shorter hospitalization or better growth. A thorough gastrointestinal evaluation must be performed before GT placement to avoid additional surgery.