Related Experiment Video
Updated: Jan 22, 2026
Defining the Role Of Language in Infants' Object Categorization with Eye-tracking Paradigms
Published on: February 8, 2019
It Is a Wrap! Or Is It?: The Role of Fundoplication in Infant Feeding Intolerance
Alejandra M Casar Berazaluce1, Alexander T Gibbons2, Rachel E Hanke1
1Department of Surgical Services, Division of Pediatric General and Thoracic Surgery, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio.
Insights
Pediatric surgeons are more likely to perform fundoplication for infants with feeding intolerance and failure to thrive (FTT), especially when neurological impairment or complex heart conditions are present. Respiratory symptoms significantly increase the likelihood of surgery in cardiac cases.
Area of Science:
- Pediatric Surgery
- Gastroenterology
- Neonatology
Background:
- Fundoplication is a common pediatric surgery, often for gastroesophageal reflux with feeding intolerance.
- Management of these cases lacks consensus, with varied approaches from medical therapy to surgical intervention.
- Infants, particularly former preemies, present complex cases with comorbidities influencing surgical decisions.
Purpose of the Study:
- To investigate the factors influencing pediatric surgeons' decisions to perform fundoplication.
- To analyze the impact of comorbidities like failure to thrive (FTT), neurological impairment, and complex cardiopathy on surgical recommendations.
- To determine the role of respiratory symptoms in fundoplication decisions for infants with cardiac conditions.
Main Methods:
- A case-based survey was administered to pediatric surgeons at a national conference.
- Clinical vignettes described infants with reflux, feeding intolerance, and varying comorbidities (FTT, neurological impairment, cardiopathy, respiratory symptoms).
- Odds ratios (ORs) were calculated to assess the likelihood of fundoplication based on presented clinical scenarios.
Main Results:
- Surgeons' decisions for fundoplication ranged from 14% to 74% across cases.
- Failure to thrive (FTT) significantly increased the odds of fundoplication (OR 1.84, P=.0002), particularly with cardiopathy (OR 3.56) or neurological impairment (OR 1.79).
- Neurological impairment (OR 1.97) and cardiopathy (OR 1.70) independently increased fundoplication odds. Concurrent FTT amplified these effects. Cardiopathy without FTT showed lower odds (OR 0.40).
Conclusions:
- Pediatric surgeons are more inclined to perform fundoplication when infants present with FTT and concurrent comorbidities.
- Neurological impairment and complex cardiopathy are significant predictors for fundoplication, especially when FTT is present.
- Respiratory symptoms strongly influence the decision for fundoplication in patients with complex cardiopathies.
Abstract:
Fundoplication is one of the most common procedures performed by pediatric surgeons, frequently for gastroesophageal reflux with feeding intolerance. No consensus exists in its management, with multiple institutions opting for medical therapy over surgical intervention. A case-based survey was administered at a national pediatric surgery conference. Clinical vignettes described former-premature infants with reflux and feeding intolerance with or without failure to thrive (FTT), neurological impairment, complex cardiopathy, and respiratory symptoms. Odds ratios (ORs) for fundoplication were calculated from participants' responses. Surgeons elected to perform fundoplication in 14%-74% of cases. The OR for performing fundoplication in the presence of FTT was 1.84 (confidence interval [CI] 1.34-2.54, P = .0002) overall, achieving significance in subgroup analysis for cardiopathy (OR 3.56, CI 1.88-6.71, P = .0001) and neurological impairment (OR 1.79, CI 1.04-3.07, P = .04), but not in the absence of these comorbidities (OR 1.05, CI 0.61-1.83, P = .86). The OR for fundoplication in the presence of neurological impairment was 1.97 (CI 1.34-2.90, P = .0005) and that for cardiopathy was 1.70 (CI 1.20-2.40, P = .003), independent of FTT status. In subgroup analysis, the greatest predictors for fundoplication were neurological impairment with FTT (OR 2.63, CI 1.55-4.48, P = .0004) and complex cardiopathy with FTT and cough/syncope (OR 7.14, CI 4.05-12.58, P < .0001). Presence of cardiopathy without FTT had the overall lowest odds of fundoplication (OR 0.40, CI 0.21-0.78, P = .006). Surgeons tend to perform fundoplication in the presence of FTT and other comorbidities, particularly when these are concurrent. Respiratory symptoms are a strong predictor for fundoplication in patients with complex cardiopathies.
Related Concept Videos
01:29Drug Dosing: Infants and Children
01:23The Role of Culture
01:02Role of Septins
Cellular Functions of Septins
Recent studies have revealed the multifaceted roles of septins in various cellular processes such as cytokinesis, ciliogenesis, and neurogenesis. Septins act as scaffolds and...
01:26Enteral Nutrition I: Orogastric and Nasogastric Feeding
Orogastric (OG) and nasogastric (NG) feeding are two standard methods used for enteral nutrition. Enteral nutrition is often preferred over...
01:15Enteral Nutrition II: Nasointestinal and Gastrostomy Feeding
Nasointestinal Feeding
Nasointestinal feeding involves placing a tube...
01:17Role of ER in the Secretory Pathway
Components of the secretory pathway
About a third of proteins synthesized in the cell are sorted via the secretory route. They shuffle between different compartments in membrane-bound vesicles until they reach their final destination. The main intracellular compartments involved...