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

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

› Author Affiliations

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

References
1 Blencowe H, Cousens S, Chou D. , et al; Born Too Soon Preterm Birth Action Group. Born too soon: the global epidemiology of 15 million preterm births. Reprod Health 2013; 10 (Suppl. 01) S2
2 Greene NH, Pham TN, Esselman PC, Rivara FP. Variation in inpatient rehabilitation utilization after hospitalization for burn injury in the United States. J Burn Care Res 2015; 36 (06) 613-618
3 Greene NH, Kernic MA, Vavilala MS, Rivara FP. Variation in pediatric traumatic brain injury outcomes in the United States. Arch Phys Med Rehabil 2014; 95 (06) 1148-1155
4 Hamlat CA, Arbabi S, Koepsell TD, Maier RV, Jurkovich GJ, Rivara FP. National variation in outcomes and costs for splenic injury and the impact of trauma systems: a population-based cohort study. Ann Surg 2012; 255 (01) 165-170
5 Rice-Townsend S, Chen C, Barnes JN, Rangel SJ. Variation in practice patterns and resource utilization surrounding management of intussusception at freestanding children's hospitals. J Pediatr Surg 2013; 48 (01) 104-110
6 Rice-Townsend S, Barnes JN, Hall M, Baxter JL, Rangel SJ. Variation in practice and resource utilization associated with the diagnosis and management of appendicitis at freestanding children's hospitals: implications for value-based comparative analysis. Ann Surg 2014; 259 (06) 1228-1234
7 Scales Jr CD, Krupski TL, Curtis LH. , et al; Urologic Diseases in America Project. Practice variation in the surgical management of urinary lithiasis. J Urol 2011; 186 (01) 146-150
8 Malcolm WF, Gantz M, Martin RJ, Goldstein RF, Goldberg RN, Cotten CM. ; National Institute of Child Health and Human Development Neonatal Research Network. Use of medications for gastroesophageal reflux at discharge among extremely low birth weight infants. Pediatrics 2008; 121 (01) 22-27
9 Clark RH, Bloom BT, Spitzer AR, Gerstmann DR. Empiric use of ampicillin and cefotaxime, compared with ampicillin and gentamicin, for neonates at risk for sepsis is associated with an increased risk of neonatal death. Pediatrics 2006; 117 (01) 67-74
10 Cotten CM, Taylor S, Stoll B. , et al; NICHD Neonatal Research Network. Prolonged duration of initial empirical antibiotic treatment is associated with increased rates of necrotizing enterocolitis and death for extremely low birth weight infants. Pediatrics 2009; 123 (01) 58-66
11 Lambert LM, Pike NA, Medoff-Cooper B. , et al; Pediatric Heart Network Investigators. Variation in feeding practices following the Norwood procedure. J Pediatr 2014; 164 (02) 237-42.e1
12 Shah SR, Jegapragasan M, Fox MD, Prince JM, Segura BJ, Kane TD. A review of laparoscopic Nissen fundoplication in children weighing less than 5 kg. J Pediatr Surg 2010; 45 (06) 1165-1168
13 McGrath-Morrow SA, Hayashi M, Aherrera AD, Collaco JM. Respiratory outcomes of children with BPD and gastrostomy tubes during the first 2 years of life. Pediatr Pulmonol 2014; 49 (06) 537-543
14 Collins CT, Makrides M, McPhee AJ. Early discharge with home support of gavage feeding for stable preterm infants who have not established full oral feeds. Cochrane Database Syst Rev 2015; (07) CD003743
15 Spitzer AR, Ellsbury DL, Handler D, Clark RH. The Pediatrix BabySteps Data Warehouse and the Pediatrix QualitySteps improvement project system--tools for “meaningful use” in continuous quality improvement. Clin Perinatol 2010; 37 (01) 49-70
16 Larsen K, Merlo J. Appropriate assessment of neighborhood effects on individual health: integrating random and fixed effects in multilevel logistic regression. Am J Epidemiol 2005; 161 (01) 81-88
17 Bennett-Guerrero E, Zhao Y, O'Brien SM. , et al. Variation in use of blood transfusion in coronary artery bypass graft surgery. JAMA 2010; 304 (14) 1568-1575
18 Bazyk S. Factors associated with the transition to oral feeding in infants fed by nasogastric tubes. Am J Occup Ther 1990; 44 (12) 1070-1078