Incidence and Description of Gastrostomy Tubes in Neonates and Infants Undergoing Congenital Cardiac Surgery

Background: Neonates and infants that undergo congenital cardiac surgery (CCS) frequently have difficulty with feeding. This is often multifactorial, but in part due to the baseline increased caloric requirement due to their cardiac condition. Studies have consistently shown that CCS and neurodevelopmental outcomes are dependent on appropriate caloric intake. Assessing the optimal feeding modality for these patients is important, but has been found to be challenging due to significant institutional variation, particularly in the case of gastrostomy tube (GT). Our study sought to report the national incidence of GT placement and describe the outcomes and characteristics in neonates and infants undergoing CCS.

Methods: We performed a retrospective review of neonates ( <1 month) and infants (1-12 months) that underwent CCS identified by ICD-10 codes utilizing a performance improvement database, Vizient Clinical Data Base. Hospitals were included if they had more than 100 neonatal CCS between the study period of November 2016 and July 2020. Patients were stratified by age at admission. Hospital outcomes and additional diagnoses were compared between admissions with and without GT (Table 1).

Results: We found an increased incidence of GT placement in neonates as compared to infants following CCS (20.6% vs 6.2%, p = <0.0001). We described the increased odds of requiring GT placement within each cohort in patients that had vocal cord paresis/paralysis, necrotizing enterocolitis, Trisomy 21, tracheostomy, and facial clefts in both neonates and infants (all p = ≤0.003).

Conclusion: This descriptive data suggests and provides a basis for better understanding the effect that age has on GT placement in this population, and supports the fact that the decision for GT placement should be multifactorial regardless of age. Additionally, it provides a better understanding of the frequency of GT nationally after CCS, allowing for quality improvement initiatives at the institutional level, and assists in defining expectations when counseling families regarding the potential requirement of a GT.