Research: Transpyloric Tube Placement Shortens Time to Full Feeding in Left Congenital Diaphragmatic Hernia

J Pediatr Surg

. 2023 Jul 5;S0022-3468(23)00401-3.

 doi: 10.1016/j.jpedsurg.2023.06.018. Online ahead of print.

Transpyloric Tube Placement Shortens Time to Full Feeding in Left Congenital Diaphragmatic Hernia

Ana Herranz Barbero 1Isabel Iglesias-Platas 2Jordi Prat-Ortells 3Jordi Clotet Caba 2Julio Moreno Hernando 2Montserrat Castañón García-Alix 3África Pertierra Cortada 2

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Background: Nutritional complications have an impact in both short- and long-term morbidity of patients with congenital diaphragmatic hernia (CDH). We aimed to compare time to full enteral tube feeding depending on route -gastric (GT) or transpyloric (TPT)- in newborns with left CDH (L-CDH).

Methods: Retrospective cohort study of L-CDH patients admitted to a referral tertiary care NICU between January 2007 and December 2014. Lethal chromosomal abnormalities and death before initiation of enteral nutrition were exclusion criteria.

Results: 37 patients were fed through GT, 46 by TPT. TPT children took 11.0 (6.8) days to reach full enteral tube feeding and spent 16.6 (8.1) days on parenteral nutrition vs 16.8 (14.7) days (p = 0.041) and 22.7 (13.5) days (p = 0.020) of GT patients. TPT children had 3.9 (2.4) days of fasting due to GI issues and 20% had episodes of decreased rates of enteral nutrition for extra-GI complications vs 11.4 (11.1) days (p = 0.028) and 49% (p = 0.006). According to the best fitting model (R2 0.383, p < 0.001), the TPT-group achieved full enteral feeding 8.4 days earlier than the GT-group (95% CI -14.76 to – 2.02 days), after adjustment by severity of illness during the first days, o/e LHR_liver and class of diaphragmatic defect. There were no differences in growth outcomes and length of stay between survivors of GT and TPT groups.

Conclusion: TPT shortens time to full enteral nutrition, especially in the most severe L-CDH patients. We propose that placement of a TPT at the end of the surgical repair procedure should be considered, especially in higher-risk patients.

Level of evidence: Treatment study, Level III. Retrospective comparative, case-control study.

Keywords: Congenital diphragmatic hernia; Enteral feeding; Gastric tube; Newborn; Transpyloric tube.

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