Gastrostomy Tube Placement in Patients With Trisomy 13 and 18: Surgical Decision Making and Outcomes

IF 2.4 2区医学 Q1 PEDIATRICS

Journal of pediatric surgery Pub Date : 2025-02-18 DOI:10.1016/j.jpedsurg.2025.162249

Sindhu V. Mannava , Rodica Muraru , Fikir M. Mesfin , Niloufar Hafezi , Zoe M. Saenz , James C. Soderstrom , Jasmin D. Sanchez , Deborah F. Billmire , Gabrielle C. Geddes , Brian W. Gray

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引用次数: 0

Abstract

Purpose

Trisomy 13 (T13) and trisomy 18 (T18) are chromosomal abnormalities which portend high rates of feeding dysfunction and infant mortality risk. Although gastrostomy tube (GT) placement is commonly performed in this population, there is limited data assessing outcomes associated with this procedure. Our aim was to determine survival outcomes among GT and non-GT patients with T13/18.

Methods

We performed a retrospective cohort study of patients with T13 and T18 treated at our institution from 2005 through 2020. We compared baseline characteristics and survival data between GT and non-GT patients and performed multivariable survival analysis.

Results

We analyzed a total of 86 patients (23 GT, 63 non-GT). Over one-third of GT patients underwent the procedure during initial admission and most GTs were used for longer than one year (60.9 %). Significantly more GT patients survived initial discharge (87 % vs. 57.1 %, p < 0.001) and were alive at follow-up (43.5 % vs. 6.3 %, p < 0.001) compared to non-GT patients. Thirty-day post-discharge survival was determined solely by GT status and not impacted by predictors. GT patients had reduced overall mortality risk compared to non-GT patients in the first year of life (HR = 0.10 [95 % CI 0.04–0.29], p < 0.001) and during the fifteen-year study period (HR = 0.15 [95 % CI 0.06–0.35], p < 0.001).

Conclusions

GT status predicted 30-day post-discharge survival in our cohort. GT patients had reduced overall mortality risk compared to non-GT patients. In patients with expected survival to initial discharge and feeding difficulty, GT placement at or after initial admission may be associated with improved survival outcomes.

Level of evidence

III.

Abstract Image

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13和18三体患者胃造口管置入：手术决策和结果

目的13三体（T13）和18三体（T18）是一种染色体异常，预示着高发的喂养功能障碍和婴儿死亡风险。虽然胃造口管（GT）放置通常在这一人群中进行，但评估该手术相关结果的数据有限。我们的目的是确定T13/18的GT和非GT患者的生存结局。方法：我们对2005年至2020年在我院治疗的T13和T18患者进行了回顾性队列研究。我们比较了GT和非GT患者的基线特征和生存数据，并进行了多变量生存分析。结果共分析86例患者，其中GT 23例，非GT 63例。超过三分之一的GT患者在初次入院时接受了手术，大多数GT使用时间超过一年（60.9%）。明显更多的GT患者在初次出院时存活(87% vs. 57.1%, p <；0.001)，随访时存活(43.5% vs. 6.3%, p <；0.001)，与非gt患者相比。出院后30天生存率仅由GT状态决定，不受预测因素影响。与非GT患者相比，GT患者在生命第一年的总死亡风险降低(HR = 0.10 [95% CI 0.04-0.29], p <；0.001)和15年研究期间(HR = 0.15 [95% CI 0.06-0.35], p <；0.001)。结论gt状态预测了我们队列患者出院后30天的生存。与非GT患者相比，GT患者的总体死亡风险降低。对于预期存活至初次出院且喂养困难的患者，在初次入院时或之后放置GT可能与改善生存结果相关。证据水平ii。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Journal of pediatric surgery 医学-外科

CiteScore

1.10

自引率

12.50%

发文量

569

审稿时长

38 days

期刊介绍： The journal presents original contributions as well as a complete international abstracts section and other special departments to provide the most current source of information and references in pediatric surgery. The journal is based on the need to improve the surgical care of infants and children, not only through advances in physiology, pathology and surgical techniques, but also by attention to the unique emotional and physical needs of the young patient.