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Gastrostomy tube placement among infants with hypoplastic left heart syndrome undergoing stage 1 palliation

Parthak Prodhan1, Xinyu Tang2, Jeffrey Gossett2

  • 1Pediatric Cardiology/Pediatric Critical Care, University of Arkansas for Medical Sciences, Arkansas Children's Hospital, Little Rock, Arkansas, USA.

Congenital Heart Disease
|May 15, 2018
PubMed

Insights

Gastrostomy tube feeding in infants with hypoplastic left heart syndrome after stage 1 palliation is associated with lower hospital mortality. This feeding strategy should be considered for infants with persistent oral feeding difficulties.

Area of Science:

  • Pediatric Cardiology
  • Neonatal Surgery
  • Critical Care Medicine

Background:

  • Infants with hypoplastic left heart syndrome (HLHS) often face feeding challenges post-stage 1 palliation.
  • Various feeding strategies are explored to enhance growth and survival in these vulnerable infants.

Purpose of the Study:

  • To evaluate the impact of gastrostomy tube feeding versus no gastrostomy tube on hospital mortality in HLHS infants following stage 1 palliation.
  • To compare mortality rates between infants receiving gastrostomy tubes with or without fundoplication.

Main Methods:

  • Retrospective analysis of a multicenter pediatric health information system database.
  • Inclusion of 4287 HLHS patients who underwent the Norwood procedure between 2004 and 2013.
  • Comparison of clinical characteristics and outcomes for infants with and without gastrostomy tubes, and those with and without fundoplication.

Main Results:

  • Infants with gastrostomy tubes showed significantly lower hospital mortality (5%) compared to those without (19%).
  • Gastrostomy tube placement was linked to longer hospital stays but improved survival likelihood (HR: 0.06).
  • Mortality was lower with isolated gastrostomy (4%) versus gastrostomy with fundoplication (8%), with fundoplication increasing mortality risk (HR: 2.77).

Conclusions:

  • Gastrostomy tube placement does not increase mortality risk for HLHS infants post-stage 1 palliation.
  • Consideration of gastrostomy tubes is recommended for HLHS infants experiencing persistent oral feeding difficulties after stage 1 palliation.
Abstract

Keywords:
gastrostomy tubehypoplastic left heart syndromeoutcomes

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