G-Tube Evaluation Guideline

Neonatology and General Surgery decision algorithm for gastrostomy tube placement in NICU patients unable to orally feed at corrected gestational age of 38 weeks Clinical Decisions Criteria for Clinical Decisions Patient meets identified G-tube criteria Does patient have pathologic reflux? Criteria for G -tube : •>= 38 week CGA AND •< 50% PO and not increasing 10%/week over a period of 4 weeks OR •Unsafe to orally feed Criteria for UGI: •Chromosomal anomaly •Complex Congenital Heart Disease(CHD) •GI anomaly •Cystic Fibrosis •Pathological reflux Yes No Consult with surgery, EPIC order placed Indications for pathologic reflux: •Inability to tolerate gastric feeds <=60 min Conduct surgical consult Discuss G -tube with family G-tube is placed Does patient have Active medical/surgical issues? Example of active surgical issues : •< 4 weeks since last abdominal surgery •Compromised abdominal wall Reconsider when issues are addressed and continue with current feeding plan Is Nissen fundoplication required ? Yes Medical Team orders UGI and UGI is completed Is UGI Required? No Yes Consideration for Nissen fundoplication: •Significant emesis w/ gastric feeds •Significant risk of aspiration •History of aspiration, severe ALTE Initial discussion with family Medical Care Team orders UGI, UGI is completed Discuss with family Does family agree to Nissen and G -tube? No Does family agree to G - tube? Yes No Nissen performed and G-tube is placed No Yes Continue with current feeding plan Neo and surgery review results and discuss if further work up is needed No Yes Updated 1/2019