title: Gastrostomy tube placement in infants with congenital diaphragmatic hernia: Frequency, predictors, and growth outcomes.
abstract: Gastrostomy 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.
  
  
  
  Determine factors associated with G-tube placement and growth in infants with congenital diaphragmatic hernia.
  
  
  
  Retrospective 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.
  
  
  
  The subjects of the study were infants with CDH treated at Duke University Medical Center from 1997 to 2013.
  
  
  
  Weight gain in infants with CDH that had G-tube placement compared to those infants with CDH that did not.
  
  
  
  Of 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 6.5g/day (95% CI: 2.5-10.4) more than infants with G-tubes.
  
  
  
  Survivors 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.
authors: Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States. Electronic address: rudras@email.chop.edu.
authors: Sharmistha
authors: S
authors: Rudra
authors: Department of Surgery, Duke University Medical Center, Durham, NC, United States. Electronic address: obinna.adibe@dm.duke.edu.
authors: Obinna O
authors: OO
authors: Adibe
authors: Department of Pediatrics, Duke University Medical Center, Durham, NC, United States. Electronic address: william.malcolm@duke.edu.
authors: William F
authors: WF
authors: Malcolm
authors: Department of Pediatrics, Duke University Medical Center, Durham, NC, United States; Duke Clinical Research Institute, Durham, NC, United States. Electronic address: brian.smith@duke.edu.
authors: P Brian
authors: PB
authors: Smith
authors: Department of Pediatrics, Duke University Medical Center, Durham, NC, United States. Electronic address: michael.cotten@duke.edu.
authors: C Michael
authors: CM
authors: Cotten
authors: Department of Pediatrics, Duke University Medical Center, Durham, NC, United States; Duke Clinical Research Institute, Durham, NC, United States. Electronic address: rachel.greenberg@duke.edu.
authors: Rachel G
authors: RG
authors: Greenberg
mesh_terms: D016022:Case-Control Studies; D002657:Child Development; D005260:Female; D005774:Gastrostomy / Q000009:adverse effects* / Q000295:instrumentation / Q000379:methods; D065630:Hernias, Diaphragmatic, Congenital / Q000601:surgery*; D006801:Humans; D007231:Infant, Newborn; D008297:Male; D011183:Postoperative Complications / Q000453:epidemiology*; D015430:Weight Gain
keywords: Feeding; G-tube; Neonate