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Feeding outcomes in tracheostomy-dependent infants - can we predict future gastrostomy tube use?
Harley Williams1, Ayushi Bhatt1, Agnieszka Dzioba2
1Schulich School of Medicine & Dentistry, Western University, London, ON, Canada.
Insights
Most infants needing a tracheostomy require nutritional support via gastrostomy tube. Concurrent placement is uncommon but may reduce anesthetic exposure and hospital stays.
Area of Science:
- Pediatric surgery
- Neonatology
- Otolaryngology
Background:
- Infants requiring tracheostomy often face feeding difficulties.
- Predicting the need for gastrostomy tube (GT) insertion is crucial for optimal care.
Purpose of the Study:
- To identify pre-operative factors predicting gastrostomy tube use in infants undergoing tracheostomy.
- To determine if gastrostomy tube insertion can be safely coordinated with tracheostomy placement.
Main Methods:
- Retrospective review of 73 infants (birth to 18 months) who underwent tracheostomy.
- Analysis of pre-operative characteristics to predict future gastrostomy tube use.
- Univariate and multivariate analyses of feeding outcomes.
Main Results:
- 75.4% of infants required a gastrostomy tube.
- Birth complications, neurologic diagnosis, comorbidities, and aspiration risk predicted gastrostomy tube need (p < 0.05).
- Only 13.5% of gastrostomy tubes were placed concurrently with tracheostomy.
Conclusions:
- The majority of infants needing tracheostomy require nutritional support.
- Concurrent tracheostomy and gastrostomy placement is infrequent but offers potential benefits.
- Coordinated placement may reduce anesthetic exposure, hospital stay, and costs.
Objectives:
To identify characteristics of infants with tracheostomy that require gastrostomy tube insertion versus those likely to orally feed to predict which patients may benefit from insertion of gastrostomy at the time of tracheostomy placement.
Methods:
Retrospective review of infants undergoing tracheostomy from birth to 18 months of age. The primary outcome was to identify pre-operative factors predictive of future gastrostomy tube use. Univariate and multivariate analyses evaluated association between pre-operative patient characteristics and feeding outcomes.
Results:
Of 103 patients identified, 73 met inclusion criteria. Upper airway anomaly was the indication for tracheostomy in 70.4 %. Gastrostomy tube was required in 52 patients (75.4 %), with 7 (13.5 %) placed concurrently with tracheostomy. Infants with birth complications, a neurologic diagnosis, multiple co-morbidities, or identified with aspiration risk were more likely to require a gastrostomy tube (p < 0.05).
Conclusions:
Most infants who require tracheostomy placement from birth until 18 months of age will require nutritional support. Tracheostomy and gastrostomy are uncommonly placed concurrently. Coordination of placement would theoretically minimize the risk of general anesthetic exposure while potentially reducing hospital length of stay and healthcare related costs.
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