A recent analysis (MG Warren et al J Pediatr 2019; 214: 41-6) examined gastrostomy tube (GT) placement among 4569 extremely low birthweight (ELBW) infants (birth wt <1000 gm) who were enrolled in the National Instittue of Child Health and Human Development Neonatal Research Network (25 centers).
- 333 (7.3%) underwent GT placement; 76% had GT placed postdischarge from NICU
- Among patients with GT placement, 56% had weight <10th percentile, 61% had neurodevelopmental impairment (NDI), and 55% had chronic breathing problems
- At last follow-up, 32% of infants who required GT placement were taking full oral feeds.
- Rates of fundoplication varied widely between centers, ranging from 0% to 6.4% among the centers.
In the discussion, the authors note the well-recognized associations between feeding difficulties and language delays in ELBW infants. In addition, “behavioral and emotional problems have …been described in children with feeding problems.”
The authors also state, without evidence, that the high rate of GT placement after discharge suggests that “a large proportion of ELBW infants were first discharged from the NICU orally feeding but could not maintain these skills.” Alternative explanations include the following:
- Many infants were sent home with NG (nasogastric) supplementation and after not making progress with oral feedings, elective GT placement was done when the infant was a more suitable candidate (eg. improved respiratory status, better nourished, etc.)
- Problems with oral feeding became apparent after discharge including poor growth and aspiration. In fact, the authors note that “orormotor dysfunction and avoidant feeding behaviors at 3 and 12 months corrected age” were nearly twice as likely in infants born <34 weeks
- While this study did not fully capture data regarding home NG feedings, 14% of patients sent home with NG feedings eventually received a GT
My take: This study indicates that 7% of ELBW infants undergo GT placement and that about one-third out-grow the need for GT supplementation after ~2 years.
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