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

Published online

Journal Article

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.

Full Text

Duke Authors

Cited Authors

  • Greene, NH; Greenberg, RG; O'Brien, SM; Kemper, AR; Miranda, ML; Clark, RH; Smith, PB

Published Date

  • December 21, 2018

Published In

PubMed ID

  • 30577056

Pubmed Central ID

  • 30577056

Electronic International Standard Serial Number (EISSN)

  • 1098-8785

Digital Object Identifier (DOI)

  • 10.1055/s-0038-1676591

Language

  • eng

Conference Location

  • United States