J Pediatr Surg

. 2021 Feb 24;S0022-3468(21)00163-9. doi: 10.1016/j.jpedsurg.2021.02.029. Online ahead of print. https://pubmed.ncbi.nlm.nih.gov/33745741/

Identifying risk factors for enteral access procedures in neonates with congenital diaphragmatic hernia: A novel risk-assessment score

James M Prieto ¹, Matthew T Harting ², Richard Y Calvo ³, Jeanne M Carroll ⁴, Alicia G Sykes ¹, Romeo C Ignacio ¹, Ashley H Ebanks ², David A Lazar ⁵, Congenital Diaphragmatic Hernia Study GroupAffiliations expand

• PMID: 33745741
• DOI: 10.1016/j.jpedsurg.2021.02.029

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Abstract

Background/purpose: The purpose of this study was to evaluate the characteristics of neonates with congenital diaphragmatic hernia (CDH) undergoing enteral access procedures (gastrostomy or jejunostomy) during their initial hospitalization, and establish a clinical scoring system based on these characteristics.

Methods: Data were obtained from the multicenter, multinational CDH Study Group database (CDHSG Registry) between 2007 and 2019. Patients were randomly partitioned into model-derivation and validation subsets. Weighted scores were assigned to risk factors based on their calculated β-coefficients after logistic regression.

Results: Of 4537 total patients, 597 (13%) underwent gastrostomy or jejunostomy tube placement. In the derivation subset, factors independently associated with an increased risk for enteral access included oxygen requirement at 30-days, chromosomal abnormalities, gastroesophageal reflux, major cardiac anomalies, ECMO requirement, liver herniation, and increased defect size. Based on the devised scoring system, patients could be stratified into very low (0-4 points; <10% risk), low (5-6 points; 10-20% risk), intermediate (7-9 points; 30-60% risk), and high risk (≥10 points; 70% risk) groups for enteral access.

Conclusion: This study identifies risk factors associated with enteral access procedures in neonates with congenital diaphragmatic hernia and establishes a novel scoring system that may be used to guide clinical decision making in those with poor oral feeding.

Type of study: Prognosis study.

Keywords: CDH; Congenital diaphragmatic hernia; Enteral access; Gastrostomy tube; Tube feedings.

Copyright © 2021. Published by Elsevier Inc.