618 - Need for surgical feeding conduit placement and timeline for removal in preterm infants born between 22 and 24 weeks of gestation

Publication Number: 618.5832

Yodika Singh, Joe DiMaggio Children's Hospital at Memorial Regional Hospital, Pembroke Pines, FL, United States; Julia Prakash, Charles E. Schmidt College of Medicine at Florida Atlantic University, Coral Springs, FL, United States; Raquel J. Garcia, Joe DiMaggio Children's Hospital, Hollywood, FL, United States; Claire Barrette, Joe DiMaggio Children's Hospital at Memorial Regional Hospital, Hollywood, FL, United States; Shenae Samuels, Memorial Healthcare System, Hollywood, FL, United States; Monica Arroyo, Joe DiMaggio Children's Hospital at Memorial Regional Hospital, Hollywood, FL, United States

Background: Extremely preterm infants, especially those born at 22-24 weeks of gestation, face significant challenges in feeding independently, often necessitating surgical gastric tube (GT) placement to meet nutritional needs. Feeding difficulties are a major concern for families preparing for NICU discharge, as safe oral feeding remains uncertain.

Objective: This study aims to assess the rates and factors associated with surgical feeding conduit placement- GT - in extremely preterm infants, as well as the timing and predictors of removal within the first two years of life.

Design/Methods: A single-center retrospective review of 72 preterm infants, born between 22 and 24 weeks of gestation between January 2018 and December 2021, was conducted. GT placement rates and associated clinical factors were analyzed, and predictors for GT removal within two years of age were assessed. Pearson’s chi-square test, Fisher’s exact test, and independent t-tests were used for statistical analyses. Statistical significance was set at P < 0.05.

Results: Among the study population, 46% required GT placement. Of note, five patients which did not require GT were discharged with a nasogastric tube and all except one of them had it removed within a few months of discharge. Infants with GT had significantly lower gestational age (23.1 vs. 23.4 weeks; P=0.004) and birth weight (532.5 vs. 596.7 g; P=0.003). GT-placed infants had lower APGAR scores at 1- and 5-minutes (2.6 vs. 3.8 P=0.020 and 4.8 vs. 6.1, P=0.009, respectively) and were more likely to have intraventricular hemorrhage (IVH) diagnosed on day of life 7 (45.5% vs. 30.8%; P=0.041). GT-placed infants also had higher IVH severity and longer NICU stays (223.6 vs. 153.4 days; P< 0.001). Tracheostomy placement was required of 18.2% of infants requiring GT. Over 30% of GT-placed infants achieved GT removal within two years. GT removal within 2 years was associated with a shorter NICU stay (193.1 vs. 232.6 days; P=0.039), lower likelihood of oxygen dependence at discharge (18.2% vs. 62.5%; P=0.015), and reduced need for feeding therapy (66.7% vs. 100.0%; P=0.008).

Conclusion(s): Our findings underscore a high rate of GT placement among extremely preterm infants born between 22 and 24 weeks of gestation with significant associations between GT placement and lower gestational age, increased IVH incidence, prolonged NICU stay, and need for respiratory support. GT removal within two years was found to be associated with a shorter NICU stay and reduced oxygen dependence, providing valuable insights for counseling families and managing care for this high-risk population.