Identifying Risk Factors for Enteral Access Procedures in Neonates with Congenital Diaphragmatic Hernia: A Novel Risk-Assessment Score
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In brief
In brief
Multicenter study of 4,537 CDH neonates identifies seven independent risk factors for requiring gastrostomy/jejunostomy, including oxygen dependence at 30 days, ECMO use, and liver herniation. Novel scoring system stratifies patients into four risk categories (very low <10% to high 70% risk) to guide early feeding intervention decisions.
Written by the GCMD Library team from the article.
Abstract
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 β-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.
Type of study
Prognosis study.