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Delayed Gastrostomy Tube Placement in Down Syndrome Patients with Duodenal Atresia Significantly Increases Length of Stay
*Nathan L Maassel, Daniel G Solomon, David Stitelman
Yale, New Haven, CT

Objective: Approximately one third of infants with duodenal atresia (DA) have concomitant Down syndrome (DS). DS patients have known feeding difficulties, and in addition to surgical repair of DA, occasionally need gastrostomy tube placement. We sought to define predictors of tube placement in DA patients with DS.
Design: Retrospective review
Setting: Children’s Hospital Association Hospitals within the Pediatric Health Information System (PHIS)
Patients: Infants <10 days old, admitted 2015-2018, ICD-10 codes for DA and DS in addition to procedure codes for intestinal bypass or duodenoduodenostomy. The cohort was additionally queried gastrostomy tube procedure codes during the same admission.
Interventions: None
Main Outcome Measures: demographics/comorbidities predictive of tube placement (primary), length of stay (secondary)
Results: 209 infants were identified with DA and DS in addition to an intestinal bypass procedure. Of those, 57 (27%) had tubes placed. On univariate analysis comparing patients with and without gastrostomy tubes, only tracheoesophageal fistula (3 with gastrostomy, 0 without, p=0.02) and length of stay (59.40 ± 47.34 days with gastrostomy vs 45.35 ± 40.36 days without) were statistically significant. When stratifying patients by timing of tube placement (during bypass N=27 vs delayed N=30) length of stay remained as the only significant difference between the two groups (44.70 ±36.72 days - tube during bypass vs 72.6 ±52.34 days - delayed tube, p=0.0032) with no significant difference in complications. Conclusions: Delayed gastrostomy tube placement in DS patients with significantly increases length of stay compared to those placed at the time of their initial operation.
Timing of Gastrostomy Tube
after(N=30)during(N=27)p-value
Birthweight (Grams)2599.08±738.282490.54 ± 709.130.480
Gestational Age in (Weeks)36.00 ± 2.9835.75 ± 3.350.947
Apgar 1 Minute Score6.00 ± 2.856.44 ± 2.660.574
Apgar 5 Minute Score7.20 ± 3.057.69 ± 2.330.816
Median Household Income (dollars)44825.67 ± 161780.4044966.30 ± 14706.000.842
Length of Stay (days)72.63 ± 52.3444.70 ± 36.720.003
Gender (Male)16(53%)11(41%)0.429
Race (Non-white)10(33%)9(33%)1
Payor (Government)19(63%)16(59%)0.752
Gastrostomy Complication5(17%)5(19%)0.722
Comorbidities
Atrial Septal Defect24(80%)16(59%)0.146
Ventricular Septal Defect14(47%)12(44%)1
Atrioventricular Septal Defect7(23%)8(29%)0.590
Tetralogy of Fallot1(3%)3(11%)0.336
Tracheoesophageal Fistula1(3%)2(7%)0.599
Anorectal Malformation1(3%)01
Annular pancreas5(17%)4(15%)1
Hirschsprung''s disease1(3%)1(4%)1


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