J Pediatr Gastroenterol Nutr

. 2021 Jun 10. doi: 10.1097/MPG.0000000000003203. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/34117194/

Factors and Growth Trends Associated with the Need for Gastrostomy Tube in Neonates with Congenital Diaphragmatic Hernia

Marisa E Schwab ¹, Shannon Burke, Mary Kate Klarich, Lan T VuAffiliations expand

• PMID: 34117194
• DOI: 10.1097/MPG.0000000000003203

Abstract

Objectives: A third of infants with congenital diaphragmatic hernia (CDH) require a gastrostomy tube (GT) for nutritional support. We compared CDH infants who are GT-dependent to those able to meet their nutritional needs orally, to identify factors associated with requiring a GT and evaluate their long-term growth.

Methods: Patients with CDH repaired at a single institution between 2012-2020 were included. Charts were retrospectively reviewed for demographic, surgical, and post-operative details. Mann-Whitney test and Fischer’s exact test were performed to compare GT-dependent neonates (n = 38, experimental) with orally fed neonates (n = 63, control). Significance was set at <0.05.

Results: Thirty-eight percent received a GT (median 67 days, IQR 50-88). GT-dependent neonates were significantly more likely to have a lower lung-to-head ratio (median 1.2, IQR 0.9-1.4, vs 1.6, IQR 1.3-2.0, IQR p < 0.0001), undergone patch or flap repair (79% vs 33%, p < 0.0001), and been hospitalized longer (median 47, IQR 24-75) vs 28 days, p < 0.0001). 14/38 had their GT removed (median 26 months, IQR 14-36). GT-dependent neonates initiated oral feeds (calculated as time since extubation) later (median 21, IQR 8-26, vs 8 days, IQR 4-13, p = 0.006). Height-for-age z-scores remained stable after GT removal, while weight-for-age z-scores dropped initially and began improving a year later.

Conclusions: The need for a gastrostomy for nutritional support is associated with more severe CDH. Over a third of patients no longer needed a GT at a median of 26 months. Linear growth generally remains stable after removal. These results may help counsel parents regarding nutritional expectations.

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Copyright © 2021 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology.