Gastrostomy Tube Use in Large-for-Gestational-Age Infants in US NICUs
Sreekanth Viswanathan, Samuel Mikhail, Harish Chandra Dega, Kera McNelisOBJECTIVE
To estimate the frequency of gastrostomy tube (GT) placement among large-for-gestational-age (LGA) infants at 35 weeks’ gestation or more, identify associated comorbidities, and quantify state-level variation.
STUDY DESIGN
Retrospective analysis of LGA infants at 35 weeks’ gestation or more in the Epic Cosmos database (2020–2024). GT placement before neonatal intensive care unit (NICU) discharge was identified using procedure codes. Mixed-effects logistic regression with a state random effect evaluated predictors.
RESULT
Among 450592 LGA infants, 295 (0.07%) received a GT. Late-preterm infants (35–36 weeks) had higher GT rates than term infants (37–40 weeks) (0.14% vs 0.04%, P < .001). In adjusted models, the strongest predictors of GT placement included feeding difficulty (aOR, 18.20), congenital cardiac disease (aOR, 7.78), Noonan syndrome (aOR, 5.16), Turner syndrome (aOR, 4.56), necrotizing enterocolitis (aOR, 3.20) and bronchopulmonary dysplasia (aOR, 2.45). State-level variation in GT placement was substantial, with a median OR of 1.83 (95% CI, 1.65–2.09), indicating that otherwise similar infants had 83% higher odds of receiving a GT based solely on their state of residence.
CONCLUSION
GT placement is rare overall but highly concentrated in LGA infants with severe comorbidities and shows significant interstate variation, suggesting practice patterns in US NICUs significantly influence surgical decision-making and outcomes.