4.4 Article

Identifying risk factors for enteral access procedures in neonates with congenital diaphragmatic hernia: A novel risk-assessment score

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JOURNAL OF PEDIATRIC SURGERY
卷 56, 期 6, 页码 1130-1134

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W B SAUNDERS CO-ELSEVIER INC
DOI: 10.1016/j.jpedsurg.2021.02.029

关键词

CDH; Enteral access; Gastrostomy tube; Tube feedings; Congenital diaphragmatic hernia

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This study evaluated the characteristics of neonates with congenital diaphragmatic hernia undergoing enteral access procedures during their initial hospitalization and established a clinical scoring system based on these characteristics to stratify patients into different risk groups for enteral access.
Background/Purpose: The purpose of this study was to evaluate the characteristics of neonates with congenital diaphragmatic hernia (CDH) undergoing enteral access procedures (gastrostomy or jejunostomy) during their initial hospitalization, and establish a clinical scoring system based on these characteristics. Methods: Data were obtained from the multicenter, multinational CDH Study Group database (CDHSG Registry) between 2007 and 2019. Patients were randomly partitioned into model-derivation and validation subsets. Weighted scores were assigned to risk factors based on their calculated beta-coefficients after logistic regression. Results: Of 4537 total patients, 597 (13%) underwent gastrostomy or jejunostomy tube placement. In the derivation subset, factors independently associated with an increased risk for enteral access included oxygen requirement at 30-days, chromosomal abnormalities, gastroesophageal reflux, major cardiac anomalies, ECMO requirement, liver herniation, and increased defect size. Based on the devised scoring system, patients could be stratified into very low (0-4 points; <10% risk), low (5-6 points; 10-20% risk), intermediate (7-9 points; 30-60% risk), and high risk (>= 10 points; 70% risk) groups for enteral access. Conclusion: This study identifies risk factors associated with enteral access procedures in neonates with congenital diaphragmatic hernia and establishes a novel scoring system that may be used to guide clinical decision making in those with poor oral feeding. Published by Elsevier Inc.

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