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

Publication ,  Journal Article
Greene, NH; Greenberg, RG; O'Brien, SM; Kemper, AR; Miranda, ML; Clark, RH; Smith, PB
Published in: Am J Perinatol
October 2019

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.

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Published In

Am J Perinatol

DOI

EISSN

1098-8785

Publication Date

October 2019

Volume

36

Issue

12

Start / End Page

1243 / 1249

Location

United States

Related Subject Headings

  • United States
  • Practice Patterns, Physicians'
  • Obstetrics & Reproductive Medicine
  • Male
  • Intensive Care, Neonatal
  • Intensive Care Units, Neonatal
  • Infant, Small for Gestational Age
  • Infant, Premature, Diseases
  • Infant, Premature
  • Infant, Newborn
 

Citation

APA
Chicago
ICMJE
MLA
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Greene, N. H., Greenberg, R. G., O’Brien, S. M., Kemper, A. R., Miranda, M. L., Clark, R. H., & Smith, P. B. (2019). Variation in Gastrostomy Tube Placement in Premature Infants in the United States. Am J Perinatol, 36(12), 1243–1249. https://doi.org/10.1055/s-0038-1676591
Greene, Nathaniel H., Rachel G. Greenberg, Sean M. O’Brien, Alex R. Kemper, Marie Lynn Miranda, Reese H. Clark, and P Brian Smith. “Variation in Gastrostomy Tube Placement in Premature Infants in the United States.Am J Perinatol 36, no. 12 (October 2019): 1243–49. https://doi.org/10.1055/s-0038-1676591.
Greene NH, Greenberg RG, O’Brien SM, Kemper AR, Miranda ML, Clark RH, et al. Variation in Gastrostomy Tube Placement in Premature Infants in the United States. Am J Perinatol. 2019 Oct;36(12):1243–9.
Greene, Nathaniel H., et al. “Variation in Gastrostomy Tube Placement in Premature Infants in the United States.Am J Perinatol, vol. 36, no. 12, Oct. 2019, pp. 1243–49. Pubmed, doi:10.1055/s-0038-1676591.
Greene NH, Greenberg RG, O’Brien SM, Kemper AR, Miranda ML, Clark RH, Smith PB. Variation in Gastrostomy Tube Placement in Premature Infants in the United States. Am J Perinatol. 2019 Oct;36(12):1243–1249.
Journal cover image

Published In

Am J Perinatol

DOI

EISSN

1098-8785

Publication Date

October 2019

Volume

36

Issue

12

Start / End Page

1243 / 1249

Location

United States

Related Subject Headings

  • United States
  • Practice Patterns, Physicians'
  • Obstetrics & Reproductive Medicine
  • Male
  • Intensive Care, Neonatal
  • Intensive Care Units, Neonatal
  • Infant, Small for Gestational Age
  • Infant, Premature, Diseases
  • Infant, Premature
  • Infant, Newborn