Rates and Risks of Gastrostomy Tubes in Infants With Cleft Palate | Congenital Defects | JAMA Otolaryngology–Head & Neck Surgery | JAMA Network
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Cooper-Brown  LCopeland  SDailey  S  et al.  Feeding and swallowing dysfunction in genetic syndromes.  Dev Disabil Res Rev 2008;14 (2) 147- 157PubMedGoogle ScholarCrossref
Reid  JReilly  SKilpatrick  N Sucking performance of babies with cleft conditions.  Cleft Palate Craniofac J 2007;44 (3) 312- 320PubMedGoogle ScholarCrossref
Baudon  JJRenault  FGoutet  JM  et al.  Assessment of dysphagia in infants with facial malformations.  Eur J Pediatr 2009;168 (2) 187- 193PubMedGoogle ScholarCrossref
Amstalden-Mendes  LGMagna  LAGil-da-Silva-Lopes  VL Neonatal care of infants with cleft lip and/or palate: feeding orientation and evolution of weight gain in a nonspecialized Brazilian hospital.  Cleft Palate Craniofac J 2007;44 (3) 329- 334PubMedGoogle ScholarCrossref
Baujat  GFaure  CZaouche  AViarme  FCouly  GAbadie  V Oroesophageal motor disorders in Pierre Robin syndrome.  J Pediatr Gastroenterol Nutr 2001;32 (3) 297- 302PubMedGoogle ScholarCrossref
Evans  AKRahbar  RRogers  GFMulliken  JBVolk  MS Robin sequence: a retrospective review of 115 patients.  Int J Pediatr Otorhinolaryngol 2006;70 (6) 973- 980PubMedGoogle ScholarCrossref
Garcez  LWGiugliani  ER Population-based study on the practice of breastfeeding in children born with cleft lip and palate.  Cleft Palate Craniofac J 2005;42 (6) 687- 693PubMedGoogle ScholarCrossref
Li  HYLo  LJChen  KSWong  KSChang  KP Robin sequence: review of treatment modalities for airway obstruction in 110 cases.  Int J Pediatr Otorhinolaryngol 2002;65 (1) 45- 51PubMedGoogle ScholarCrossref
Lidsky  MELander  TASidman  JD Resolving feeding difficulties with early airway intervention in Pierre Robin sequence.  Laryngoscope 2008;118 (1) 120- 123PubMedGoogle ScholarCrossref
Reid  JKilpatrick  NReilly  S A prospective, longitudinal study of feeding skills in a cohort of babies with cleft conditions.  Cleft Palate Craniofac J 2006;43 (6) 702- 709PubMedGoogle ScholarCrossref
Smedegaard  LMarxen  DMoes  JGlassou  ENScientsan  C Hospitalization, breast-milk feeding, and growth in infants with cleft palate and cleft lip and palate born in Denmark.  Cleft Palate Craniofac J 2008;45 (6) 628- 632PubMedGoogle ScholarCrossref
Smith  MCSenders  CW Prognosis of airway obstruction and feeding difficulty in the Robin sequence.  Int J Pediatr Otorhinolaryngol 2006;70 (2) 319- 324Google ScholarCrossref
Pagano  MGauvreau  K Principles of Biostatistics.  Belmont, CA Duxbury Press1993;
Chuacharoen  RRitthagol  WHunsrisakhun  JNilmanat  K Felt needs of parents who have a 0- to 3-month-old child with a cleft lip and palate.  Cleft Palate Craniofac J 2009;46 (3) 252- 257PubMedGoogle ScholarCrossref
Johansson  BRingsberg  KC Parents' experiences of having a child with cleft lip and palate.  J Adv Nurs 2004;47 (2) 165- 173PubMedGoogle ScholarCrossref
Reid  J A review of feeding interventions for infants with cleft palate.  Cleft Palate Craniofac J 2004;41 (3) 268- 278PubMedGoogle ScholarCrossref
Masarei  AGSell  DHabel  AMars  MSommerlad  BCWade  A The nature of feeding in infants with unrepaired cleft lip and/or palate compared with healthy noncleft infants.  Cleft Palate Craniofac J 2007;44 (3) 321- 328PubMedGoogle ScholarCrossref
Karayazgan  BGunay  YGurbuzer  BErkan  MAtay  A A preoperative appliance for a newborn with cleft palate.  Cleft Palate Craniofac J 2009;46 (1) 53- 57PubMedGoogle ScholarCrossref
Peters  RTBalduyck  BNour  S Gastrostomy complications in infants and children: a comparative study.  Pediatr Surg Int 2010;26 (7) 707- 709PubMedGoogle ScholarCrossref
Rio  AEllis  CShaw  C  et al.  Nutritional factors associated with survival following enteral tube feeding in patients with motor neurone disease.  J Hum Nutr Diet 2010;23 (4) 408- 415PubMedGoogle ScholarCrossref
Sullivan  PB Gastrointestinal disorders in children with neurodevelopmental disabilities.  Dev Disabil Res Rev 2008;14 (2) 128- 136PubMedGoogle ScholarCrossref
Godbole  PMargabanthu  GCrabbe  DC  et al.  Limitations and uses of gastrojejunal feeding tubes.  Arch Dis Child 2002;86 (2) 134- 137PubMedGoogle ScholarCrossref
Saenz  RBBeebe  DKTriplett  LC Caring for infants with congenital heart disease and their families.  Am Fam Physician 1999;59 (7) 1857- 1868PubMedGoogle Scholar
Ciotti  GHolzer  RPozzi  MDalzell  M Nutritional support via percutaneous endoscopic gastrostomy in children with cardiac disease experiencing difficulties with feeding.  Cardiol Young 2002;12 (6) 537- 541PubMedGoogle ScholarCrossref
Hofner  GBehrens  RKoch  ASinger  HHofbeck  M Enteral nutritional support by percutaneous endoscopic gastrostomy in children with congenital heart disease.  Pediatr Cardiol 2000;21 (4) 341- 346PubMedGoogle ScholarCrossref
Sheikh  SAllen  EShell  R  et al.  Chronic aspiration without gastroesophageal reflux as a cause of chronic respiratory symptoms in neurologically normal infants.  Chest 2001;120 (4) 1190- 1195PubMedGoogle ScholarCrossref
Heuschkel  RBFletcher  KHill  ABuonomo  CBousvaros  ANurko  S Isolated neonatal swallowing dysfunction: a case series and review of the literature.  Dig Dis Sci 2003;48 (1) 30- 35PubMedGoogle ScholarCrossref
Durkin  ETSchroth  MKHelin  MShaaban  AF Early laparoscopic fundoplication and gastrostomy in infants with spinal muscular atrophy type I.  J Pediatr Surg 2008;43 (11) 2031- 2037PubMedGoogle ScholarCrossref
Meyer  ACLidsky  MESampson  DELander  TALiu  MSidman  JD Airway interventions in children with Pierre Robin Sequence.  Otolaryngol Head Neck Surg 2008;138 (6) 782- 787PubMedGoogle ScholarCrossref
Srinivasan  RO’Neill  CBlumenow  WDalzell  AM Perceptions of caregivers following percutaneous endoscopic gastrostomy in children with congenitally malformed hearts.  Cardiol Young 2009;19 (5) 507- 510PubMedGoogle ScholarCrossref
Original Article
March 21, 2011

Rates and Risks of Gastrostomy Tubes in Infants With Cleft Palate

Author Affiliations

Author Affiliations: Departments of Otolaryngology, Children's Hospitals and Clinics of Minnesota and University of Minnesota (Ms Cu and Dr Sidman), and Pediatric ENT Associates (Dr Sidman), Minneapolis.

Arch Otolaryngol Head Neck Surg. 2011;137(3):275-281. doi:10.1001/archoto.2011.18

Objectives  To review data on a cohort of infants with cleft palate to (1) determine rates of gastrostomy (G)-tube placement, (2) identify contributing comorbidities, and (3) use relative risk analyses to improve management of cleft palate in infants with feeding difficulty.

Design  Retrospective medical record review.

Setting  Tertiary care children's hospital.

Patients  Infants with cleft palate born between January 1, 2000, and December 31, 2008, without G-tubes prior to referral were included. Comorbidities were analyzed, including syndromes and chromosomopathies (syn/chrom) and cardiac, respiratory, neurologic, and gastrointestinal diagnoses. These comorbidities were analyzed independently.

Main Outcome Measure  Gastrostomy-tube placement.

Results  Of 214 infants with cleft palate, 34 required G-tubes. Of these, 19 had syn/chrom. Independent of these diagnoses, 17 infants had 1 system comorbidity and 12 had multisystem comorbidities. Of the 180 patients without G-tubes, 20 had syn/chrom. Independent of these diagnoses, 10 infants had 1 system comorbidity and 2 had multisystem comorbidities. Rates of G-tube placement ranged from 3% in infants without any comorbidity to 94% in infants with respiratory comorbidity. Relative risks of G-tube placement with syn/chrom, 1 system comorbidity, and multisystem comorbidities were 5.68 (95% confidence interval, 3.18-10.16), 21.79 (8.76-54.17), and 29.66 (12.18-72.21), respectively.

Conclusions  Diagnosis of syn/chrom or major comorbidity significantly increases risk of G-tube placement. Regardless of syn/chrom association, problems affecting the heart, respiratory system, central nervous system, and lower esophageal sphincter are the most significant risk factors, implying that particular comorbidities are more influential than a simple diagnosis of syn/chrom. These data should help identify children at greatest risk for G-tubes and those expected to overcome feeding difficulties, leading to more persistent use of nonsurgical therapy before resorting to G-tubes.