Fingland Stephanie, Ascencio Andy, Diaz-Miron Jose, Barrett Cindy, Hills-Dunlap Jonathan, Partrick David A, Acker Shannon N
Division of Pediatric Surgery, Children's Hospital Colorado, University of Colorado School of Medicine, 13123 E 16 Ave. Box 323, Aurora, CO, 80045, USA.
Section of Cardiology, Department of Pediatrics, Children's Hospital Colorado, University of Colorado School of Medicine, Aurora, CO, USA.
Pediatr Cardiol. 2024 Nov 18. doi: 10.1007/s00246-024-03694-4.
Our aim is to determine the rate of unexpected malrotation identified on routine preoperative upper gastrointestinal (UGI) contrast study in infants with congenital heart disease (CHD) prior to gastrostomy tube (GT) placement and quantify any associated delay in care. We performed a retrospective review of infants with CHD who underwent GT placement following initial cardiac surgery at a single center between 2016 and 2021. Patients were identified in the electronic medical record. Demographic information, indications for GT placement, and clinical course were collected. Variables were compared using Mann-Whitney test, with significance set at p < 0.05. One hundred and thirty-one infants with CHD underwent GT placement after cardiac surgery; 124 (94.7%) underwent preoperative UGI of which 119 (95.2%) were normal. Five studies were read as "could not rule out malrotation" and one infant had malrotation on UGI. Median time from UGI to surgery was 3 days. Median days from consult to GT placement was 3 days among those who underwent UGI and 2 days in those who did not (p = 0.34). Among infants with CHD, the rate of unknown malrotation is low. UGI contrast study prior to GT placement may be associated with surgical delay, unnecessary radiation exposure, and low value healthcare. If a child is tolerating gastric feeds prior to GT placement, routine UGI is unnecessary.
我们的目的是确定先天性心脏病（CHD）患儿在放置胃造口管（GT）之前，常规术前上消化道（UGI）造影检查中意外旋转不良的发生率，并量化任何相关的护理延迟。我们对2016年至2021年期间在单一中心接受初次心脏手术后放置GT的CHD患儿进行了回顾性研究。通过电子病历识别患者。收集人口统计学信息、GT放置的指征和临床病程。使用曼-惠特尼检验比较变量，显著性设定为p < 0.05。131例CHD患儿在心脏手术后接受了GT放置；124例（94.7%）进行了术前UGI检查，其中119例（95.2%）结果正常。5份检查报告解读为“不能排除旋转不良”，1例患儿UGI检查显示有旋转不良。从UGI检查到手术的中位时间为3天。接受UGI检查的患儿从会诊到放置GT的中位天数为3天，未接受UGI检查的患儿为2天（p = 0.3）。在CHD患儿中，不明旋转不良的发生率较低。GT放置前的UGI造影检查可能与手术延迟、不必要的辐射暴露和低价值医疗保健有关。如果患儿在GT放置前能够耐受胃饲，常规UGI检查则不必要。
