title: Preemptive gastrostomy tube placement after Norwood operation.
abstract: OBJECTIVE
  Because infants undergoing a Norwood operation have poor interstage weight gain, we hypothesized that preemptive gastrostomy tube (GT) placement would result in earlier discharge, improved growth, and higher survival to stage 2.
  
  
  METHODS
  Records of 74 neonates who underwent a Norwood operation were reviewed until stage 2 palliation. The patients were divided into conventional (n = 43) and preemptive GT groups (n = 31). Data included demographics, cardiac surgery, feeding strategy, length of hospitalization, and mortality.
  
  
  RESULTS
  Transplant-free survival to stage 2 was significantly higher in the preemptive group, but there were no significant differences in survival to discharge after stage 1, length of hospitalization, and weight-for-age z-score at discharge and at stage 2 palliation. In the conventional group, 27 of 43 underwent GT placement, all via laparotomy, 23 with Nissen fundoplication. In the preemptive group, all underwent GT placement (21 laparoscopic, 10 laparotomy), 7 with Nissen fundoplication. A second gastric intervention was performed in 11 of 21 with laparoscopic GT (7 conversion to gastrojejunostomy tube, 4 Nissen fundoplication).
  
  
  CONCLUSIONS
  Preemptive GT placement is associated with improved survival to stage 2 after a Norwood operation but not with shorter hospitalization or better growth. A thorough gastrointestinal evaluation must be performed before GT placement to avoid additional surgery.
authors: Department of Pediatrics, Division of Pediatric Cardiology, Arkansas Children's Hospital and University of Arkansas for Medical Sciences, Little Rock, AR, USA. GarciaXiomara@uams.edu
authors: Xiomara
authors: X
authors: Garcia
authors: Robert D B
authors: RD
authors: Jaquiss
authors: Michiaki
authors: M
authors: Imamura
authors: Christopher J
authors: CJ
authors: Swearingen
authors: Melvin S
authors: MS
authors: Dassinger
authors: Ritu
authors: R
authors: Sachdeva