title: Predictors of gastrostomy placement in children with inherited metabolic diseases treated by umbilical cord blood transplantation.
abstract: OBJECTIVE
  Children with inherited metabolic diseases (IMDs) undergoing umbilical cord blood transplantation (UCBT) who are at risk for post-transplant failure to thrive may benefit from pretransplant gastrostomy tube (GT) placement. Here we sought to determine predictors of posttransplant failure to thrive.
  
  
  METHODS
  A retrospective analysis was performed for IMD patients who underwent UCBT at a single center from 2001 to 2011. Patients who received GTs were compared with controls. Multivariable logistic regression was used to determine significant predictors for GT placement. Recursive partitioning was performed to determine appropriate cut-offs for significant continuous variables.
  
  
  RESULTS
  Two hundred and seventeen patients met inclusion criteria of which twenty-three were excluded due to death within one hundred days of transplant. Forty (20.6%) of the remaining patients underwent a surgical GT placement. Multivariable logistic regression demonstrated that weight percentile at time of transplant was significantly associated with GT placement (Adjusted odds ratio (AOR): 0.87 per 10th percentile, p=0.022). Recursive partitioning demonstrated that the 40th weight percentile at time of transplant was an optimal cut-off for predicting GT placement.
  
  
  CONCLUSIONS
  Patients preparing for umbilical cord transplantation who are below the 40th percentile for weight may benefit from pre-emptive GT placement prior to transplant.
authors.affiliation: Department of Surgery, Duke University School of Medicine, DUMC Box 3704, Durham, NC 27710.
authors.forename: Brian C
authors.initials: BC
authors.lastname: Gulack
authors.affiliation: Division of Pediatric Surgery, Duke University School of Medicine, DUMC Box 3815, Durham, NC 27710.
authors.forename: Michelle
authors.initials: M
authors.lastname: Schweitzer
authors.affiliation: Department of Surgery, Duke University School of Medicine, DUMC Box 3704, Durham, NC 27710.
authors.forename: Brian R
authors.initials: BR
authors.lastname: Englum
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University Medical Center, 2424 Erwin Rd, Suite 1102 Hock Plaza, Box 2721, Durham, NC 27710.
authors.forename: Maragatha
authors.initials: M
authors.lastname: Kuchibhatla
authors.affiliation: Division of Pediatric Blood Marrow Transplantation, Duke University School of Medicine, DUMC Box 3350, Durham, NC 27705.
authors.forename: Vinod K
authors.initials: VK
authors.lastname: Prasad
authors.affiliation: Division of Pediatric Surgery, Duke University School of Medicine, DUMC Box 3815, Durham, NC 27710. Electronic address: obinna.adibe@duke.edu.
authors.forename: Obinna O
authors.initials: OO
authors.lastname: Adibe
mesh_terms: D001835:Body Weight; D016022:Case-Control Studies; D002648:Child; D002675:Child, Preschool; D005183:Failure to Thrive / Q000209:etiology / Q000628:therapy*; D005260:Female; D005312:Fetal Blood / Q000637:transplantation*; D005774:Gastrostomy; D006801:Humans; D016015:Logistic Models; D008297:Male; D008659:Metabolic Diseases / Q000401:mortality / Q000628:therapy*; D015999:Multivariate Analysis; D012189:Retrospective Studies
keywords: Gastrostomy; Inherited metabolic disease; Umbilical cord blood transplantation