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

• Infants with congenital diaphragmatic hernia (CDH) often require gastrostomy tube placement.
• The risk factors that predict gastrostomy tube placement and the nutritional outcomes in infants with CDH are unknown.
• This study explores risk factors associated with gastrostomy tube placement and growth velocity in infants with CDH.

BackgroundGastrostomy 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.AimsDetermine factors associated with G-tube placement and growth in infants with congenital diaphragmatic hernia.Study designRetrospective 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.SubjectsThe subjects of the study were infants with CDH treated at Duke University Medical Center from 1997 to 2013.Outcome measuresWeight gain in infants with CDH that had G-tube placement compared to those infants with CDH that did not.ResultOf 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.ConclusionSurvivors 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.