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Updated: Nov 11, 2025
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Published on: April 17, 2020
Primary contributors to gastrostomy tube placement in infants with Congenital Diaphragmatic Hernia
Hannah Fleming1, Allison G Dempsey2, Claire Palmer3
1Department of Audiology, Speech and Learning, Children's Hospital Colorado. (Aurora, CO), Boulder, CO 80309, USA.
Insights
Gastrostomy tube (GT) placement in infants with congenital diaphragmatic hernia (CDH) is associated with prenatal lung volumes, stomach position, and postnatal factors like prolonged NPO status and feeding difficulties. Early identification of these risk factors can optimize GT timing and reduce hospital stays.
Area of Science:
- Neonatal Surgery
- Pediatric Gastroenterology
- Congenital Anomalies
Background:
- Congenital diaphragmatic hernia (CDH) is a complex condition requiring multidisciplinary care.
- Infants with CDH often face challenges with nutrition and growth, necessitating feeding support.
- Gastrostomy tube (GT) placement is a common intervention for nutritional support in these infants.
Purpose of the Study:
- To identify key factors predicting the need for gastrostomy tube (GT) placement in infants diagnosed with congenital diaphragmatic hernia (CDH).
- To analyze prenatal, perinatal, and postnatal characteristics associated with GT placement in a cohort of CDH infants.
- To inform clinical decision-making regarding the timing of GT insertion to improve outcomes.
Main Methods:
- Retrospective cohort study of 114 surviving infants with CDH (2010-2019).
- Comparison of prenatal, perinatal, and postnatal factors between infants with and without GT placement.
- Logistic regression and elastic net regularized regression used to identify predictive variables for GT placement.
Main Results:
- 43.9% of surviving CDH infants received a GT.
- Predictive prenatal factors included low percent predicted lung volume (PPLV <21%), total lung volume (TLV <30 ml), and lung-head ratio (LHR <1.2).
- Postnatal factors associated with GT placement included prolonged NPO status, delayed transition to bolus feeds, gastro-esophageal reflux (GER), and need for extracorporeal membrane oxygenation (ECMO).
Conclusions:
- Prenatal lung volumes and stomach position are significant predictors of GT need in CDH infants.
- Postnatal factors such as prolonged NPO duration and feeding difficulties are strongly associated with GT placement.
- Identifying these risk factors can help optimize the timing of GT insertion, potentially preventing prolonged hospitalizations related to feeding issues.
Objective:
To identify factors associated with gastrostomy tube (GT) placement in infants with congenital diaphragmatic hernia (CDH).
Methods:
Retrospective cohort study of 114 surviving infants with CDH at a single tertiary care neonatal intensive care unit from 2010-2019. Prenatal, perinatal and postnatal characteristics were compared between patients who were discharged home with and without a GT. Prenatal imaging was available for 50.9% of the cohort. Logistic regression was used to assess the association between GT placement and pertinent clinical factors. ROC curves were generated, and Youden's J statistic was used to determine optimal predictive cutoffs for continuous variables. Elastic net regularized regression was used to identify variables associated with GT placement in multivariable analysis.
Results:
GT was placed in 43.9% of surviving infants with CDH. Prenatal variables predictive of GT placement were percent predicted lung volume (PPLV) <21%, total lung volume (TLV) <30 ml, lung-head ratio (LHR) <1.2 or observed to expected LHR (O/E LHR) <55%. Infants who required a GT were diagnosed earlier prenatally (23.6 ± 3.4 vs. 26.4 ± 5.6 weeks). Patients whose stomach was above the diaphragm on prenatal ultrasound (up) had a higher odds of GT placement compared to those with stomachs below the diaphragm (down) position by a factor of 2.9 (95% CI: 1.25, 7.1); p = 0.0154. Postnatally, infants with GT had lower Apgar scores at 1 and 5 min, longer lengths of stay and higher proportion of flap closures. Infants with a type C or D defect and extracorporeal membrane oxygenation (ECMO) were associated with increased odds of needing a GT. Postnatal association included being NPO for >12 days, need for transpyloric (TP) feeds for >10 days, >14 days to transition to a 30 min bolus feed, presence of gastro-esophageal reflux (GER), chronic lung disease and pulmonary hypertension. In multivariable analysis, duration of NPO, time to TP feeds, transition to 30 min bolus feeds remained significantly associated with GT placement after adjusting for severity of pulmonary hypertension (PH), GER diagnosis and sildenafil treatment.
Conclusion:
Identification of risk factors associated with need for long-term feeding access may improve timing of GT placement and prevent prolonged hospitalization related to feeding issues.
Level Of Evidence Rating:
Level II (Retrospective Study).
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