Gastrostomy Tube Feeding in Extremely Low Birthweight Infants: Frequency, Associated Comorbidities, and Long-term Outcomes

• Type of Material: Article
• Authors: M. G. Warren, Duke University; Barbara Do, RTI International; Abhik Das, RTI International; P. Brian Smith, Duke University; Ira Adams-Chapman, Emory University; Sudarshan Jadcherla, Nationwide Childrens Hospital; Erik A. Jensen, Childrens Hospital of Philadelphia; Ricki F. Goldstein, Duke University; Ronald N. Goldberg, Duke University; C. Michael Cotten, Duke University; Edward F. Bell, University of Iowa; William F. Malcolm, Duke University; David Carlton, Emory University; Sheena Carter, Emory University; Barbara Stoll, Emory University; Brenda Poindexter, Emory University
• Language: English
• Date: 2019-11-01
• Publisher: Mosby-Elsevier
• Publication Version: Author Accepted Manuscript (After Peer Review)
• Copyright Statement: © 2019 Elsevier Inc. All rights reserved.
• License: Creative Commons Attribution-NonCommercial-NoDerivs 4.0 International
• Final Published Version (URL): http://dx.doi.org/10.1016/j.jpeds.2019.06.066
• Title of Journal or Parent Work: Journal of Pediatrics
• Volume: 214
• Start Page: 41
• End Page: +
• Grant/Funding Information: None declared
• Keywords: Children; Coordination; Pediatrics; Respiration; Life Sciences & Biomedicine; Necrotizing enterocolitis; Early discharge; Preterm infants; Impact; Home; Science & Technology
• Research Categories: Health Sciences, Health Care Management; Psychology, Developmental; Health Sciences, Medicine and Surgery; Health Sciences, Human Development

Abstract

Objective: To assess the frequency of gastrostomy tube (GT) placement in extremely low birth weight (ELBW) infants, associated co-morbidities, and long-term outcomes. Study design: Analysis of ELBW infants from 25 centers enrolled in the National Institute of Child Health and Human Development Neonatal Research Network’s Generic Database and Follow-up Registry from 2006-2012. Frequency of GT placement before 18-22 months, demographic and medical factors associated with GT placement, and associated long-term outcomes at 18-22 months corrected age were described. Associations between GT placement and neonatal morbidities and long-term outcomes were assessed with logistic regression after adjustment for center and common covariables. Results: Of the 4549 ELBW infants included in these analyses, 333 (7.3%) underwent GT placement; 76% had the GT placed post-discharge. Of infants with GTs, 11% had birth weights small for gestational age (SGA), 77% had bronchopulmonary dysplasia (BPD), and 29% severe intraventricular hemorrhage (IVH) or periventricular leukomalacia (PVL). At follow-up, 56% of infants with a GT had weight <10th percentile, 61% had neurodevelopmental impairment (NDI), and 55% had chronic breathing problems. After adjustment, SGA, BPD, IVH/PVL, poor growth and NDI were associated with GT placement. Thirty-two percent of infants with GTs placed were taking full oral feeds at follow-up. Conclusions: GT placement is common in ELBW infants, particularly among those with severe neonatal morbidities. GT placement in this population was associated with poor growth, NDI and chronic respiratory and feeding problems at follow-up. The frequency of GT placement post-neonatal discharge indicates the need for close nutritional follow-up of ELBW infants.