(202) Clinical Characteristics of Children with Cystic Fibrosis Who Receive Gastrostomy Tubes

Background: Gastrostomy tubes (g-tubes) are commonly employed as a tool for optimizing enteral nutrition in patients with cystic fibrosis (CF). However, few studies have explored the characteristics of children with CF who undergo g-tube placement.

Methods: We compared clinical characteristics including demographics, method of diagnosis, nutritional interventions, and chronic pulmonary medication use among patients who received g-tubes versus those who did not between the years of 2003-2019 within the Cystic Fibrosis Foundation Patient Registry (CFFPR). Date of g-tube placement is not available in the CFFPR, so we identified the year of g-tube placement as the first year where the presence of a g-tube was indicated. Being malnourished was defined according to CDC weight-for-age z-scores (WFAz < -1). We used chi-square tests for categorical variables and Student t-tests for continuous variables.

Results: There were 10,185 total children with CF in the CFFPR that met inclusion criteria, including 2,337 (22.9%) with a g-tube. Mean (95% CI) age at g-tube placement was 4.25 (4.12, 4.39) years. Compared to children who did not receive a g-tube during the study period, a higher proportion of children who received a g-tube were diagnosed via meconium ileus (16% vs 28%, respectively) or failure to thrive (11% vs 22%), had only Class I-III CFTR mutations (78% vs 87%), ever used dornase alfa (21% vs 30%), and were malnourished in the year of entry into the CFFPR (35% vs 65%). There were no substantial differences in sex, age at diagnosis, race/ethnicity, pancreatic enzyme replacement therapy, use of anti-reflux therapies, supplemental feedings, infection with Pseudomonas aeruginosa, or Medicaid/state insurance [Table 1].

Conclusions: To our knowledge, this is the first CFFPR data analysis describing patient characteristics that were associated with g-tube placement. Our findings may inform providers and parents alike in making clinical decisions with respect to children with CF at-risk for g-tube placement. Particular attention to early malnourishment as a potentially modifiable risk factor that may help to avoid g-tube placement.

Acknowledgements: The authors thank the CFF for the use of CFFPR data to conduct the study. This work was supported by the Cystic Fibrosis Foundation 3^rd Year Clinical Fellowship Grant [WALL21D0]

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