National and regional trends in gastrostomy in very low birth weight infants in the USA: 2000–2012

Hatch, L. Dupree; Scott, Theresa A; Walsh, William F.; Goldin, Adam B.; Blakely, Martin L.; Patrick, Stephen W.

doi:10.1038/s41372-018-0145-4

Cited by 27 publications

(13 citation statements)

References 28 publications

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“…19 Large multisite studies of neonates 20 and children 21 with neurologic impairment and gastrostomy experienced similar gastrointestinal or respiratory related admissions, with or without fundoplication. Fundoplication variably accompanies gastrostomy 7 and use could be increasing 6 despite no clear evidence of respiratory health advantages. Ongoing surveillance with detailed physiologic studies to identify those with severe pharyngeal dysfunction is necessary to establish the indications for fundoplication in children who also require gastrostomy feeding, as well as further studies assessing the usefulness of thickened feeds in for severely impaired children still capable of swallowing.…”

Section: Original Articlesmentioning

confidence: 99%

Risk of Hospitalizations Following Gastrostomy in Children with Intellectual Disability

Jacoby

Wong

Srasuebkul

et al. 2020

The Journal of Pediatrics

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Objective To examine the frequency of hospital admissions before and after gastrostomy insertion in children with severe intellectual disability. Study designWe conducted a retrospective cohort study using linked health administrative and disability data from Western Australia (WA) and New South Wales (NSW). Children born between 1983 and 2009 in WA and 2002 and 2010 in NSW who had a gastrostomy insertion performed (n = 673 [WA, n = 325; NSW, n = 348]) by the end of 2014 (WA) and 2015 (NSW) were included. Conditional Poisson regression models were used to evaluate the ageadjusted effect of gastrostomy insertion on acute hospitalizations for all-cause, acute lower respiratory tract infections (LRTI), and epilepsy admissions. ResultsThe incidence of all-cause hospitalizations declined at 5 years after procedure (WA cohort 1983(WA cohort -2009 incidence rate ratio, 0.70 [95% CI, 0.60-0.80]; WA and NSW cohort 2002-2010: incidence rate ratio, 0.63 [95% CI, 0.45-0.86]). Admissions for acute LRTI increased in the WA cohort and remained similar in the combined cohort. Admissions for epilepsy decreased 4 years after gastrostomy in the WA cohort and were generally lower in the combined cohort. Fundoplication seemed to decrease the relative incidence of acute LRTI admissions in the combined cohort.Conclusions Gastrostomy was associated with health benefits including reduced all-cause and epilepsy hospitalizations, but was not protective against acute LRTI. These decreases in hospitalizations may reflect improved delivery of nutrition and medications.

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Section: Original Articlesmentioning

confidence: 99%

Risk of Hospitalizations Following Gastrostomy in Children with Intellectual Disability

Jacoby

Wong

Srasuebkul

et al. 2020

The Journal of Pediatrics

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Section: Introductionmentioning

confidence: 99%

“…With improved survival rates of more critically ill neonates, the national rate of G-tube placement has doubled from 2000 to 2012 (Hatch et al, 2018). Complications of G-tube placement and removal often lead to subsequent hospitalizations or procedures after discharge from the nursery (McSweeney et al, 2015;Khalil et al, 2017;Hatch et al, 2018). At the Medical University of South Carolina (MUSC), preterm infants who have not reached full PO feeds by 40-week gestational age (GA) and/or after 40 days of attempting PO feeds have a >90% chance of eventually needing G-tube implantation to achieve full enteral feeds (Ryan and Gehle, 2019).…”

Section: Introductionmentioning

confidence: 99%

Transcutaneous Auricular Vagus Nerve Stimulation-Paired Rehabilitation for Oromotor Feeding Problems in Newborns: An Open-Label Pilot Study

Badran

Jenkins

Cook

et al. 2020

Front. Hum. Neurosci.

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Neonates born premature or who suffer brain injury at birth often have oral feeding dysfunction and do not meet oral intake requirements needed for discharge. Low oral intake volumes result in extended stays in the hospital (>2 months) and can lead to surgical implant and explant of a gastrostomy tube (G-tube). Prior work suggests pairing vagus nerve stimulation (VNS) with motor activity accelerates functional improvements after stroke, and transcutaneous auricular VNS (taVNS) has emerged as promising noninvasive form of VNS. Pairing taVNS with bottle-feeding rehabilitation may improve oromotor coordination and lead to improved oral intake volumes, ultimately avoiding the need for G-tube placement. We investigated whether taVNS paired with oromotor rehabilitation is tolerable and safe and facilitates motor learning in infants who have failed oral feeding. We enrolled 14 infants [11 premature and 3 hypoxic-ischemic encephalopathy (HIE)] who were slated for G-tube placement in a prospective, open-label study of taVNS-paired rehabilitation to increase feeding volumes. Once-daily taVNS was delivered to the left tragus during bottle feeding for 2 weeks, with optional extension. The primary outcome was attainment of oral feeding volumes and weight gain adequate for discharge without G-tube while also monitoring discomfort and heart rate (HR) as safety outcomes. We observed no adverse events related to stimulation, and stimulation-induced HR reductions were transient and safe and likely confirmed vagal engagement. Eight of 14 participants (57%) achieved adequate feeding volumes for discharge without G-tube (mean treatment length: 16 ± 6 days). We observed significant increases in feeding volume trajectories in responders compared with pre-stimulation (p < 0.05). taVNS-paired feeding rehabilitation appears safe and may improve oral feeding in infants with oromotor dyscoordination, increasing the rate of discharge without G-tube, warranting larger controlled trials.

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“…2018; Hatch et al . 2018). We recently reported that use of gastrostomy insertion among children with ID who were younger than 3 years increased 5.4% per annum [95% confidence interval (CI) 3.4, 7.3] over the period 1983–2014 (Glasson et al .…”

Section: Introductionmentioning

confidence: 99%

Survival of children and adolescents with intellectual disability following gastrostomy insertion

Wong

Glasson

Jacoby

et al. 2020

J intellect Disabil Res

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Background Positive health outcomes have been observed following gastrostomy insertion in children with intellectual disability, which is being increasingly used at younger ages to improve nutritional intake. This study investigated the effect of gastrostomy insertion on survival of children with severe intellectual disability. Methods We used linked disability and health data of children and adolescents who were born in Western Australia between 1983 and 2009 to compare survival of individuals with severe intellectual disability by exposure to gastrostomy status. For those born in 2000–2009, we employed propensity score matching to adjust for confounding by indication. Effect of gastrostomy insertion on survival was compared by pertinent health and sociodemographic risk factors. Results Compared with children born in the 1980s–1990s, probability of survival following first gastrostomy insertion for those born in 2000–2009 was higher (2 years: 94% vs. 83%). Mortality risk was higher in cases than that in their matched controls (hazard ratio 2.9, 95% confidence interval 1.1, 7.3). The relative risk of mortality (gastrostomy vs. non‐gastrostomy) may have differed by sex, birthweight and time at first gastrostomy insertion. Respiratory conditions were a common immediate or underlying cause of death among all children, particularly among those undergoing gastrostomy insertion. Conclusions Whilst gastrostomy insertion was associated with lower survival rates than children without gastrostomy, survival improved with time, and gastrostomy afforded some protection for the more vulnerable groups, and earlier use appears beneficial to survival. Specific clinical data that may be used to prioritise the need for gastrostomy insertion may be responsible for the survival differences observed.

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National and regional trends in gastrostomy in very low birth weight infants in the USA: 2000–2012

Abstract: Between 2000 and 2012, the incidence of GT in VLBW infants doubled, associated with improvements in survival in this population.

Cited by 27 publications

References 28 publications

Risk of Hospitalizations Following Gastrostomy in Children with Intellectual Disability

Risk of Hospitalizations Following Gastrostomy in Children with Intellectual Disability

Transcutaneous Auricular Vagus Nerve Stimulation-Paired Rehabilitation for Oromotor Feeding Problems in Newborns: An Open-Label Pilot Study

Survival of children and adolescents with intellectual disability following gastrostomy insertion

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