Document Detail

Rates and risks of gastrostomy tubes in infants with cleft palate.
MedLine Citation:
PMID:  21422313     Owner:  NLM     Status:  In-Data-Review    
OBJECTIVES: To review data on a cohort of infants with cleft palate to (1) determine rates of gastrostomy (G)-tube placement, (2) identify contributing comorbidities, and (3) use relative risk analyses to improve management of cleft palate in infants with feeding difficulty.
DESIGN: Retrospective medical record review.
SETTING: Tertiary care children's hospital.
PATIENTS: Infants with cleft palate born between January 1, 2000, and December 31, 2008, without G-tubes prior to referral were included. Comorbidities were analyzed, including syndromes and chromosomopathies (syn/chrom) and cardiac, respiratory, neurologic, and gastrointestinal diagnoses. These comorbidities were analyzed independently.
MAIN OUTCOME MEASURE: Gastrostomy-tube placement.
RESULTS: Of 214 infants with cleft palate, 34 required G-tubes. Of these, 19 had syn/chrom. Independent of these diagnoses, 17 infants had 1 system comorbidity and 12 had multisystem comorbidities. Of the 180 patients without G-tubes, 20 had syn/chrom. Independent of these diagnoses, 10 infants had 1 system comorbidity and 2 had multisystem comorbidities. Rates of G-tube placement ranged from 3% in infants without any comorbidity to 94% in infants with respiratory comorbidity. Relative risks of G-tube placement with syn/chrom, 1 system comorbidity, and multisystem comorbidities were 5.68 (95% confidence interval, 3.18-10.16), 21.79 (8.76-54.17), and 29.66 (12.18-72.21), respectively.
CONCLUSIONS: Diagnosis of syn/chrom or major comorbidity significantly increases risk of G-tube placement. Regardless of syn/chrom association, problems affecting the heart, respiratory system, central nervous system, and lower esophageal sphincter are the most significant risk factors, implying that particular comorbidities are more influential than a simple diagnosis of syn/chrom. These data should help identify children at greatest risk for G-tubes and those expected to overcome feeding difficulties, leading to more persistent use of nonsurgical therapy before resorting to G-tubes.
Sharon R Cu; James D Sidman
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Publication Detail:
Type:  Journal Article    
Journal Detail:
Title:  Archives of otolaryngology--head & neck surgery     Volume:  137     ISSN:  1538-361X     ISO Abbreviation:  Arch. Otolaryngol. Head Neck Surg.     Publication Date:  2011 Mar 
Date Detail:
Created Date:  2011-03-22     Completed Date:  -     Revised Date:  -    
Medline Journal Info:
Nlm Unique ID:  8603209     Medline TA:  Arch Otolaryngol Head Neck Surg     Country:  United States    
Other Details:
Languages:  eng     Pagination:  275-81     Citation Subset:  AIM; IM    
Pediatric ENT Associates, Children's Specialty Center, 2530 Chicago Ave S, Ste 450, Minneapolis, MN 55404.;
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