Gastrostomy tube placement among infants with hypoplastic left heart syndrome undergoing stage 1 palliation
2018; Wiley; Volume: 13; Issue: 4 Linguagem: Inglês
10.1111/chd.12610
ISSN1747-0803
AutoresParthak Prodhan, Xinyu Tang, Jeffrey M. Gossett, Brandon Beam, Janet M. Simsic, Nancy S. Ghanayem, Nahed O. ElHassan,
Tópico(s)Neonatal Respiratory Health Research
ResumoCongenital Heart DiseaseVolume 13, Issue 4 p. 519-527 ORIGINAL ARTICLE Gastrostomy tube placement among infants with hypoplastic left heart syndrome undergoing stage 1 palliation Parthak Prodhan MD, Corresponding Author Parthak Prodhan MD prodhanparthak@uams.edu orcid.org/0000-0002-7413-8075 Pediatric Cardiology/Pediatric Critical Care, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, USACorrespondence Parthak Prodhan, MD, Department of Pediatrics, Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR 72202. Email: prodhanparthak@uams.eduSearch for more papers by this authorXinyu Tang PhD, Xinyu Tang PhD Biostatistics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, USASearch for more papers by this authorJeffrey Gossett MS, Jeffrey Gossett MS Biostatistics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, USASearch for more papers by this authorBrandon Beam JD, MS, Brandon Beam JD, MS Bioinformatics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, USASearch for more papers by this authorJanet Simsic MD, Janet Simsic MD orcid.org/0000-0003-2420-7009 Pediatric Cardiology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USASearch for more papers by this authorNancy Ghanayem MD, Nancy Ghanayem MD Cardiac Critical Care, Department of Pediatrics, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USASearch for more papers by this authorNahed O. ElHassan MD, MPH, Nahed O. ElHassan MD, MPH Neonatology, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, USASearch for more papers by this author Parthak Prodhan MD, Corresponding Author Parthak Prodhan MD prodhanparthak@uams.edu orcid.org/0000-0002-7413-8075 Pediatric Cardiology/Pediatric Critical Care, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, USACorrespondence Parthak Prodhan, MD, Department of Pediatrics, Arkansas Children's Hospital, 1 Children's Way, Little Rock, AR 72202. Email: prodhanparthak@uams.eduSearch for more papers by this authorXinyu Tang PhD, Xinyu Tang PhD Biostatistics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, USASearch for more papers by this authorJeffrey Gossett MS, Jeffrey Gossett MS Biostatistics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, USASearch for more papers by this authorBrandon Beam JD, MS, Brandon Beam JD, MS Bioinformatics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, USASearch for more papers by this authorJanet Simsic MD, Janet Simsic MD orcid.org/0000-0003-2420-7009 Pediatric Cardiology, Department of Pediatrics, Nationwide Children's Hospital, Columbus, Ohio, USASearch for more papers by this authorNancy Ghanayem MD, Nancy Ghanayem MD Cardiac Critical Care, Department of Pediatrics, Medical College of Wisconsin/Children's Hospital of Wisconsin, Milwaukee, Wisconsin, USASearch for more papers by this authorNahed O. ElHassan MD, MPH, Nahed O. ElHassan MD, MPH Neonatology, Department of Pediatrics, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, USASearch for more papers by this author First published: 13 May 2018 https://doi.org/10.1111/chd.12610Citations: 9 This study was first presented (poster) in 2015 at the Society of Pediatric Research, San Diego, USA. Read the full textAboutPDF ToolsRequest permissionExport citationAdd to favoritesTrack citation ShareShare Give accessShare full text accessShare full-text accessPlease review our Terms and Conditions of Use and check box below to share full-text version of article.I have read and accept the Wiley Online Library Terms and Conditions of UseShareable LinkUse the link below to share a full-text version of this article with your friends and colleagues. Learn more.Copy URL Share a linkShare onFacebookTwitterLinkedInRedditWechat Abstract Objective Different feeding strategies have been suggested to improve growth and survival of infants with hypoplastic left heart syndrome following stage 1 palliation. The study objective was to assess hospital mortality following stage 1 palliation among infants with hypoplastic left heart syndrome who had two feeding modalities, gastrostomy tube vs no gastrostomy tube. Design Retrospective study design. Setting Multicenter pediatric heath information system database. Patient About 4287 patients with hypoplastic left heart syndrome who underwent stage 1 Norwood procedure from 2004 through 2013. Infants who had gastrostomy tube with or without fundoplication procedure were identified and their clinical characteristics were compared. Intervention None. Outcomes Measures The primary outcome was discharge hospital mortality following stage 1 palliation. Results About 1214 patients who underwent stage 1 palliation had gastrostomy tube placement prior to hospital discharge. About 881 only had this procedure, while 333 patients also underwent fundoplication. Infants who had a gastrostomy tube placement vs no gastrostomy procedure had longer hospital stay, but significantly lower hospital mortality (5% vs 19%, P < .001). Hospital mortality was lower in infants who had only gastrostomy vs gastrostomy with fundoplication procedure (4% vs 8%, P = .004). In the multivariable analysis, gastrostomy procedure was associated with a higher likelihood of survival to hospital discharge (HR: 0.06, CI [0.04, 0.1]), whereas additional fundoplication procedure increased the risk of mortality (HR: 2.77, CI [1.52, 5.04]). Conclusions The gastrostomy procedure did not place infants with hypoplastic left heart syndrome at higher risk of mortality. These infants should be considered for gastrostomy tube placement if they had persistent difficulty in oral feeding following stage 1 palliation. CONFLICT OF INTEREST None. Citing Literature Supporting Information Additional Supporting Information may be found online in the supporting information tab for this article. Filename Description chd12610-sup-0001-FigureS1.tiffTIFF image, 5.6 MB Figure S1. Flow diagram showing description of the study cohort. chd12610-sup-0002-FigureS2.tiffTIFF image, 1.5 MB Figure S2. Center variation for case count (GT ± FP and No GT) (upper graph) and discharge hospital mortality (GT ± FP and No GT) (lower graph). chd12610-sup-0003-TableS1-S6.docxWord document, 72.3 KB Table S1. Diagnosis, procedures, and pharmacological agents, and corresponding codes. Table S2. Discharge hospital mortality among infants who survived or remained hospitalized beyond the first month of life. Table S3. Tabulation of comorbidities among infants who had a gastrostomy procedure. Table S4. Comparison of outcomes among infants in the gastrostomy tube feeding group who had any comorbidity versus no comorbidity. Table S5. Univariate and multivariable Cox regression for time-to-death for infants who remained hospitalized or survived at one month of life. Table S6. Univariate and multivariable logistic regression for evaluation of predictors of prolonged length of hospital stay (LOS>52 days). Please note: The publisher is not responsible for the content or functionality of any supporting information supplied by the authors. Any queries (other than missing content) should be directed to the corresponding author for the article. Volume13, Issue4July/August 2018Pages 519-527 RelatedInformation
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