E. Mahdi1, N. Tran2, S. Ourshalimian1, S. Sanborn3, M. Alquiros2, D. Lascano1, C. Herrington2, L. Kelley-Quon1,4 1Children’s Hospital Los Angeles,Division Of Pediatric Surgery,Los Angeles, CALIFORNIA, USA 2Children’s Hospital Los Angeles,Division Of Cardiac Surgery,Los Angeles, CALIFORNIA, USA 3Children’s Hospital Los Angeles,Department Of Clinical Nutrition And Lactation Services,Los Angeles, CALIFORNIA, USA 4University Of Southern California,Department Of Preventive Medicine,Los Angeles, CA, USA
Introduction: Children with congenital heart disease (CHD) often experience feeding intolerance due to aspiration, inability to tolerate feed volume, or reflux within the first few months of life, requiring surgical gastrostomy tube (GT) placement for durable enteral access prior to being discharged. However, complications after hospital discharge related to GT use are common, making optimization of outpatient care and management of family expectations paramount. The purpose of the study is to identify clinical factors associated with continued GT use one-year following GT placement.
Methods: We performed a retrospective cohort study using the Society of Thoracic Surgeons database and our tertiary care children’s hospital’s electronic medical record from 2014-2019. Children less than 1 year old with CHD who underwent cardiac surgery and GT placement between January 2014 – October 2019 were identified. Patient demographics, pre-operative feeding regimen, CHD clinical variables, and GT-related utilization in the year following discharge were evaluated. Bivariate analyses using chi-square for categorical variables and student’s t-test for continuous variables were performed on the GT use at one year vs non-use cohorts to identify factors associated with continued GT use one year after being discharged.
Results: Overall, 137 infants with CHD received a GT, with 115 (84%) demonstrating continued GT use at 1 year after surgery. Factors associated with continued GT use at one-year after discharge included lower total percent of goal oral feed tolerance prior to GT surgery (5.3±10.0% vs. 17.1±24.8%, p-value=0.010), prolonged hospitalization after GT placement (≥2 weeks) (35.7% vs. 13.6%, p-value=0.048), and failure to tolerate oral feeds in addition to GT feeds at time of discharge (72.7% vs. 31.3%, p-value<0.001). There was no difference in patient demographic or clinical factors such as gestational age, gender, race/ethnicity, insurance status, CHD defect, non-cardiac abnormalities, or chromosomal abnormalities between groups. Clinic or emergency room visits related to a GT complication were common and did not differ between groups.
Conclusion: Patients with CHD who underwent GT placement and exhibited minimal oral nutrition prior to GT placement, prolonged hospitalization after GT placement, and those not tolerating oral feeds at time of discharge are more likely to use their GT one-year after discharge. Quality improvement efforts to optimize care for this high-risk, device-dependent infant population are warranted to maximize growth and development, minimize risks, and facilitate family engagement for long-term outpatient care.
