Gastrostomy tube placement in infants with congenital diaphragmatic hernia: Frequency, predictors, and growth outcomes

• Published in: Early human development Vol. 103; pp. 97 - 100
• Main Authors: Rudra, Sharmistha, MD, Adibe, Obinna O., MD MHS, Malcolm, William F., MD, Smith, P. Brian, MD MPH MHS, Cotten, C. Michael, MD MHS, Greenberg, Rachel G., MD MHS
• Format: Journal Article
• Language: English
• Published: Ireland Elsevier B.V 01.12.2016
• Subjects: Advanced Basic Science; Case-Control Studies; Child Development; Feeding; Female; G-tube; Gastrostomy - adverse effects; Gastrostomy - instrumentation; Gastrostomy - methods; Hernias, Diaphragmatic, Congenital - surgery; Humans; Infant, Newborn; Male; Neonatal and Perinatal Medicine; Neonate; Postoperative Complications - epidemiology; Weight Gain; ECMO; intensive care nursery; OT; CDH; PPI; chronic lung disease; proton pump inhibitor; Feeding; resting energy expenditure; GERD; G-tube; REE; Neonate; gastrostomy tube; ICN; pulmonary function tests; congenital diaphragmatic hernia; CLD; extracorporeal membrane oxygenation; gastroesophageal reflux disease; occupational therapy; PFT
• ISSN: 0378-3782; 1872-6232; 1872-6232
• DOI: 10.1016/j.earlhumdev.2016.08.003

Abstract Background Gastrostomy tube (G-tube) placement is a common intervention for newborns with severe feeding difficulties. Infants with congenital diaphragmatic hernia (CDH) are at high risk for feeding problems. Prevalence of G-tube placement and consequent nutritional outcomes of infants with CDH and G-tubes has not been described. Aims Determine factors associated with G-tube placement and growth in infants with congenital diaphragmatic hernia. Study design Retrospective cohort study of infants with CDH to evaluate the association of G-tube placement with risk factors using logistic regression. We also assessed the association between growth velocity and G-tube placement and other risk factors using linear regression. Subjects The subjects of the study were infants with CDH treated at Duke University Medical Center from 1997 to 2013. Outcome measures Weight gain in infants with CDH that had G-tube placement compared to those infants with CDH that did not. Result Of the 123 infants with CDH, 85 (69%) survived and G-tubes were placed in 25/85 (29%) survivors. On adjusted analysis, extracorporeal membrane oxygenation (OR = 11.26 [95% CI: 1.92–65.89]; P = 0.01) and proton pump inhibitor use (OR = 17.29 [3.98–75.14], P ≤ 0.001) were associated with G-tube placement. Infants without G-tubes had a growth velocity of 6.5 g/day (95% CI: 2.5–10.4) more than infants with G-tubes. Conclusion Survivors with more complex inpatient courses were more likely to receive G-tubes. Further investigation is needed to identify optimal feeding practices for infants with CDH.