Utilization of Gastrostomy Tubes in the Neonatal Population Undergoing Congenital Heart Surgery: Can We Devise a Risk Factor Model to Define Optimal Timing for Placement?
Kevin M. Beers, DO1, S. Adil Husain, MD2, Aaron Bettenhausen, MD1, Thomas J. Prihoda, PhD1.
1University of Texas Health San Antonio, San Antonio, TX, USA, 2University of Utah Health, Salt Lake City, UT, USA.
Objective(s): Neonates undergoing repair of congenital heart defects require optimized nutritional support in the perioperative period. In particular, nutritional markers have been associated with outcomes metrics in the single ventricle inter-stage period. Utilization of a gastrostomy tube (GT) is not infrequent, yet optimal timing for placement is ill-defined.
Methods: A single-institution, retrospective chart review identified 64 consecutive neonates who underwent cardiac operations requiring cardiopulmonary bypass from 2012-2016. Perioperative variables were evaluated for significance in relation to GT placement.
Results: A total of 27 (42%) required GT placement. Diagnosis of a genetic syndrome significantly increased risk of GT (p=0.032). Patients with single ventricle physiology were at risk (p=0.0013) compared to two-ventricle patients. Aortic arch reconstruction at primary operation (p=0.029), as well as the need for delayed sternal closure (p=0.05) were also at increased risk. Post-operative outcomes including, number of days intubated (p=0.0026), and moderate, or worse dysphagia (p=0.0034) were predictors of GT. Additionally, genetic syndrome (p=0.003), aortic arch reconstruction (p=0.01) and postoperative intubation duration (p=0.0024) predicted increased length of stay, where length of stay was directly related to GT placement (p=0.0004).
Conclusions: Neonates undergoing repair of congenital heart defects may require a GT for nutritional supplementation. Early recognition of risk factors may allow for reduced time to GT, and in turn improve perioperative growth and outcomes, parental satisfaction, while also reducing overall length of stay.
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