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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

Nathaniel H. Greene
1   Division of Pediatric Anesthesia, Department of Anesthesiology, Duke University School of Medicine, Durham, North Carolina
,
Rachel G. Greenberg
2   Division of Neonatology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
3   Duke Clinical Research Institute, Durham, North Carolina
,
Sean M. O'Brien
3   Duke Clinical Research Institute, Durham, North Carolina
4   Department of Biostatistics, Duke University School of Medicine, Durham, North Carolina
,
Alex R. Kemper
3   Duke Clinical Research Institute, Durham, North Carolina
5   Division of Pediatric Primary Care, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
,
Marie Lynn Miranda
6   Department of Statistics, Rice University, Houston, Texas
,
Reese H. Clark
7   Pediatrix Medical Group, Sunrise, Florida
,
P. Brian Smith
2   Division of Neonatology, Department of Pediatrics, Duke University School of Medicine, Durham, North Carolina
3   Duke Clinical Research Institute, Durham, North Carolina
› Author Affiliations Funding N.H.G. receives salary support for research from the Centers for Disease and Control and Prevention (1 NU50DD004933-01-00), and Iroko Pharmaceuticals for pediatric drug development. R.G.G. receives salary support for research from a National Institutes of Health (NIH) training grants (5T32HD043029-13), NIH awards (HHSN 275201000003I, HHSN 272201300017I), and from the Food and Drug Administration (HHSF223201610082C). P.B.S. receives salary support for research from the National Institutes of Health (NIH) and the National Center for Advancing Translational Sciences of the NIH (1R21HD080606-01A1), the National Institute of Child Health and Human Development (HHSN275201000003I), and the Food and Drug Administration (1R18-FD005292–01); he also receives research support from industry for neonatal and pediatric drug development (www.dcri.duke.edu/research/coi.jsp). M.L.M. receives salary support from the US Centers for Disease Control and Prevention, the National Institute of Mental Health, and the Bristol-Myers Squibb Foundation.
Further Information

Publication History

23 February 2018

31 October 2018

Publication Date:
21 December 2018 (online)

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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
 

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