Preemptive gastrostomy tube placement after Norwood operation.

Abstract

OBJECTIVE:

Because infants undergoing a Norwood operation have poor interstage weight gain, we hypothesized that preemptive gastrostomy tube (GT) placement would result in earlier discharge, improved growth, and higher survival to stage 2.

STUDY DESIGN:

Records of 74 neonates who underwent a Norwood operation were reviewed until stage 2 palliation. The patients were divided into conventional (n = 43) and preemptive GT groups (n = 31). Data included demographics, cardiac surgery, feeding strategy, length of hospitalization, and mortality.

RESULTS:

Transplant-free survival to stage 2 was significantly higher in the preemptive group, but there were no significant differences in survival to discharge after stage 1, length of hospitalization, and weight-for-age z-score at discharge and at stage 2 palliation. In the conventional group, 27 of 43 underwent GT placement, all via laparotomy, 23 with Nissen fundoplication. In the preemptive group, all underwent GT placement (21 laparoscopic, 10 laparotomy), 7 with Nissen fundoplication. A second gastric intervention was performed in 11 of 21 with laparoscopic GT (7 conversion to gastrojejunostomy tube, 4 Nissen fundoplication).

CONCLUSION:

Preemptive GT placement is associated with improved survival to stage 2 after a Norwood operation but not with shorter hospitalization or better growth. A thorough gastrointestinal evaluation must be performed before GT placement to avoid additional surgery.

• Authors: Xiomara Garcia, Robert D B Jaquiss, Michiaki Imamura, Christopher J Swearingen, Melvin S Dassinger 3rd, Ritu Sachdeva
• Journal: The Journal of pediatrics (J Pediatr) Vol. 159 Issue 4 Pg. 602-7.e1 (Oct 2011) ISSN: 1097-6833 [Electronic] United States
• PMID: 21601220 (Publication Type: Comparative Study, Journal Article)
• Copyright: Copyright © 2011 Mosby, Inc. All rights reserved.

Topics

• Female
• Fundoplication
• Gastrostomy
• Humans
• Hypoplastic Left Heart Syndrome (mortality, surgery)
• Infant, Newborn (growth & development)
• Laparoscopy
• Laparotomy
• Length of Stay (statistics & numerical data)
• Male
• Norwood Procedures
• Postoperative Complications (prevention & control)
• Preoperative Care
• Retrospective Studies
• Weight Gain