Predictors of Gastrostomy tube dependence in infants with complex congenital heart disease

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ESPR379
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Abstract: :

Background: While feeding difficulties are common in infants with congenital heart disease (CHD) following cardiac surgery, the prevalence of gastrostomy tube (G-tube) is variable in this population. Identification and better understanding of risk factors for G-tube placement in infants with complex CHD will offer improved pre- and post-natal counseling with education to parents and the ICU providers. 


Objective: We hypothesized a higher requirement of G-tube dependence in neonates with more complex types of CHD. Determinants of feeding difficulty and risk factors associated with the need for G-tube in neonates with complex CHD was examined.


Design/Methods: A retrospective medical record review of 105 infants with a prenatal diagnosis of complex CHD of atrio-ventricular septal defect (N=23), double outlet right ventricle (N=13), transposition of the great arteries (N=13), tetralogy of Fallot (TOF, N=32), truncus arteriosus (N=2) and hypoplastic left heart syndrome (HLH, N=22) that were initially admitted to the NICU between 2015-2019 was performed. The study analyzed infants with the above diagnosis for non-modifiable (birth weight (BW), gestational age (GA), Apgars, chromosomal abnormality, type of defect) and modifiable risk factor variables including cardiopulmonary bypass time, days on invasive and non-invasive ventilation, timing of initiation of enteral feeds pre- and postoperatively, age of G-tube placement and length of hospital stay. A uni- and multi-variate regression was performed to determine significance of G-tube placement and types of CHD. Data is stated as mean ± S.D or %; p<0.05 was considered significant.


Results: Of the 105  infants with the above diagnoses, 44 infants required G-tube (42%) compared to no G-tube (N=61; 58%). No significant association was observed between G-tube placement and BW, GA at birth, chromosomal abnormalities, cardiopulmonary bypass time or type of CHD. Days on noninvasive ventilation (4.80±5.73 vs. 14.23±27.60), intubation days (4.42±8.46 vs. 16.18±30, p=0.005), age at which gavage feeds started postoperatively (2.48± 2.39 vs. 4.93±5.41, p= 0.018) and time to reach full enteral feeds (5.67±6.11 vs. 10.86±13.66, p=0.036) were associated with higher need for G-tube placement. On multi-variate regression, significant predictor of G-tube was <2 days of invasive ventilation (p=0.037) and age at which gavage feeds were started post-operatively (p=0.018). Infants with HLH had higher risk of requiring G-tube when associated with prolonged time to reach full enteral feeds postoperatively (OR 1.07; C.I (1.007-1.137; p=0.03) compared to other types of CHD. 


Conclusions: Shorter duration of invasive respiratory support (≤ 2days) and early initiation of post-operative feeds rather than the type of CHD remain important predictors of G-tube placement. Recognition of G-tube predictors will improve anticipatory guidance to families and ICU providers during counseling sessions to support this high-risk population.


University of Maryland School of Medicine
University of School of Medicine
University of School of Medicine
University of School of Medicine
University of School of Medicine
University of Maryland School of Medicine

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