Variation in Gastrostomy Tube Placement in Premature Infants in the United States

Nathaniel H. Greene; Rachel G. Greenberg; Sean M. O'Brien; Alex R. Kemper; Marie Lynn Miranda; Reese H. Clark; P. Brian Smith

doi:10.1055/s-0038-1676591

American Journal of Perinatology, Table of Contents

Am J Perinatol 2019; 36(12): 1243-1249
DOI: 10.1055/s-0038-1676591

Original Article

Thieme Medical Publishers 333 Seventh Avenue, New York, NY 10001, USA.

Variation in Gastrostomy Tube Placement in Premature Infants in the United States

Authors

Nathaniel H. Greene

¹Division of Pediatric Anesthesia, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
Rachel G. Greenberg

²Division of Neonatology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina

³Duke Clinical Research Institute, Durham, North Carolina
Sean M. O'Brien

³Duke Clinical Research Institute, Durham, North Carolina

⁴Department of Biostatistics, Duke University School of Medicine, Durham, North Carolina
Alex R. Kemper

³Duke Clinical Research Institute, Durham, North Carolina

⁵Division of Pediatric Primary Care, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
Marie Lynn Miranda

⁶Department of Statistics, Rice University, Houston, Texas
Reese H. Clark

⁷Pediatrix Medical Group, Sunrise, Florida
P. Brian Smith

²Division of Neonatology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina

³Duke Clinical Research Institute, Durham, North Carolina

Abstract

Objective To describe the variation in surgical gastrostomy tube (SGT) placement in premature infants among neonatal intensive care units (NICUs) in the United States.

Study Design We identified 8,781 premature infants discharged from 114 NICUs in the Pediatrix Medical Group from 2010 to 2012. The outcome of interest was SGT placement prior to discharge home from an NICU. Unadjusted proportions and adjusted risk estimates were calculated to quantify variation observed among individual NICUs.

Results SGT placement occurred in 360 of 8,781 (4.1%) of infants. Across NICUs, any gastrostomy tube placement ranged from none in 45 NICUs up to 19.6%. Adjusted risk estimates for factors associated with SGT placement included gestational age at birth (odds ratio [OR]: 0.7/week, 95% confidence interval[CI]: [0.65, 0.75]), small for gestational age status (OR: 2.78 [2.09, 3.71]), administration of antenatal steroids (OR: 0.69 [0.52, 0.92]), Hispanic ethnicity (OR: 0.54 [0.37, 0.78]), and higher 5-minute Apgar scores (7–10, OR: 0.54 [0.37, 0.79]).

Conclusion Individual NICU center has a strong clinical effect on the probability of SGT placement relative to other medical factors. Future work is needed to understand the cause of this variation and the degree to which it represents over or under use of gastrostomy tubes.

Keywords

premature infant - nutrition - surgical - feeding

Full Text

References

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