Rudra Sharmistha, Adibe Obinna O, Malcolm William F, Smith P Brian, Cotten C Michael, Greenberg Rachel G
Department of Pediatrics, Children's Hospital of Philadelphia, Philadelphia, PA, United States.
Department of Surgery, Duke University Medical Center, Durham, NC, United States.
Early Hum Dev. 2016 Dec;103:97-100. doi: 10.1016/j.earlhumdev.2016.08.003. Epub 2016 Aug 22.
Gastrostomy tube (G-tube) placement is a common intervention for newborns with severe feeding difficulties. Infants with congenital diaphragmatic hernia (CDH) are at high risk for feeding problems. Prevalence of G-tube placement and consequent nutritional outcomes of infants with CDH and G-tubes has not been described.
Determine factors associated with G-tube placement and growth in infants with congenital diaphragmatic hernia.
Retrospective cohort study of infants with CDH to evaluate the association of G-tube placement with risk factors using logistic regression. We also assessed the association between growth velocity and G-tube placement and other risk factors using linear regression.
The subjects of the study were infants with CDH treated at Duke University Medical Center from 1997 to 2013.
Weight gain in infants with CDH that had G-tube placement compared to those infants with CDH that did not.
Of the 123 infants with CDH, 85 (69%) survived and G-tubes were placed in 25/85 (29%) survivors. On adjusted analysis, extracorporeal membrane oxygenation (OR=11.26 [95% CI: 1.92-65.89]; P=0.01) and proton pump inhibitor use (OR=17.29 [3.98-75.14], P≤0.001) were associated with G-tube placement. Infants without G-tubes had a growth velocity of 6.5g/day (95% CI: 2.5-10.4) more than infants with G-tubes.
Survivors with more complex inpatient courses were more likely to receive G-tubes. Further investigation is needed to identify optimal feeding practices for infants with CDH.
胃造瘘管（G管）置入是对有严重喂养困难的新生儿的常见干预措施。患有先天性膈疝（CDH）的婴儿存在喂养问题的高风险。CDH婴儿及使用G管后的G管置入率和相应营养结局尚未见描述。
确定与先天性膈疝婴儿G管置入及生长相关的因素。
对CDH婴儿进行回顾性队列研究，采用逻辑回归评估G管置入与危险因素的关联。我们还使用线性回归评估生长速度与G管置入及其他危险因素之间的关联。
本研究的对象是1997年至2013年在杜克大学医学中心接受治疗的CDH婴儿。
比较置入G管的CDH婴儿与未置入G管的CDH婴儿的体重增加情况。
123例CDH婴儿中，85例（69%）存活，25/85例（29%）存活者置入了G管。经校正分析，体外膜肺氧合（OR = 11.26 [95% CI：1.92 - 65.89]；P = 0.01）和使用质子泵抑制剂（OR = 17.29 [3.98 - 75.14]，P≤0.001）与G管置入相关。未置入G管的婴儿的生长速度比置入G管的婴儿快6.5克/天（95% CI：2.5 - 10.4）。
住院过程更复杂的存活者更有可能接受G管。需要进一步研究以确定CDH婴儿的最佳喂养方式。
