title: Rates and risks of gastrostomy tubes in infants with cleft palate.
abstract: OBJECTIVE
  To review data on a cohort of infants with cleft palate to (1) determine rates of gastrostomy (G)-tube placement, (2) identify contributing comorbidities, and (3) use relative risk analyses to improve management of cleft palate in infants with feeding difficulty.
  
  
  METHODS
  Retrospective medical record review.
  
  
  METHODS
  Tertiary care children's hospital.
  
  
  METHODS
  Infants with cleft palate born between January 1, 2000, and December 31, 2008, without G-tubes prior to referral were included. Comorbidities were analyzed, including syndromes and chromosomopathies (syn/chrom) and cardiac, respiratory, neurologic, and gastrointestinal diagnoses. These comorbidities were analyzed independently.
  
  
  METHODS
  Gastrostomy-tube placement.
  
  
  RESULTS
  Of 214 infants with cleft palate, 34 required G-tubes. Of these, 19 had syn/chrom. Independent of these diagnoses, 17 infants had 1 system comorbidity and 12 had multisystem comorbidities. Of the 180 patients without G-tubes, 20 had syn/chrom. Independent of these diagnoses, 10 infants had 1 system comorbidity and 2 had multisystem comorbidities. Rates of G-tube placement ranged from 3% in infants without any comorbidity to 94% in infants with respiratory comorbidity. Relative risks of G-tube placement with syn/chrom, 1 system comorbidity, and multisystem comorbidities were 5.68 (95% confidence interval, 3.18-10.16), 21.79 (8.76-54.17), and 29.66 (12.18-72.21), respectively.
  
  
  CONCLUSIONS
  Diagnosis of syn/chrom or major comorbidity significantly increases risk of G-tube placement. Regardless of syn/chrom association, problems affecting the heart, respiratory system, central nervous system, and lower esophageal sphincter are the most significant risk factors, implying that particular comorbidities are more influential than a simple diagnosis of syn/chrom. These data should help identify children at greatest risk for G-tubes and those expected to overcome feeding difficulties, leading to more persistent use of nonsurgical therapy before resorting to G-tubes.
authors.affiliation: Department of Otolaryngology, Children's Hospitals and Clinics of Minnesota and University of Minnesota, Minneapolis, MN, USA.
authors.forename: Sharon R
authors.initials: SR
authors.lastname: Cu
authors.forename: James D
authors.initials: JD
authors.lastname: Sidman
mesh_terms: D002869:Chromosome Aberrations; D002972:Cleft Palate / Q000235:genetics / Q000503:physiopathology / Q000628:therapy*; D015897:Comorbidity; D004750:Enteral Nutrition / Q000706:statistics & numerical data*; D005260:Female; D005774:Gastrostomy / Q000706:statistics & numerical data*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D008297:Male; D012189:Retrospective Studies; D012307:Risk Factors; D013577:Syndrome; D014600:Utilization Review / Q000706:statistics & numerical data