Percutaneous endoscopic gastrostomy (PEG) placement in medically complex infants weighing less than 3.5 kilograms

Although, medically complex infants may require prolonged supplemental nutritional support, there is often hesitancy in using nasogastric feedings in this population at home due to risk of tube dislodgement. Percutaneous endoscopic gastrostomy (PEG) placement, an established procedure for pediatric patients, could benefit this population, however, there is still relatively little information regarding its feasibility and safety in very small infants. We report our experience with PEG placement in a series of infants weighing less than 3.5 kg. Methods: A retrospective chart review from January 1995 to July 1997 found 10 infants weighing less than 3.5 kgs who received PEGs. No infant had been discharged from the hospital prior to PEG placement. Mean weight and age at PEG insertion were 2.9 kg (range 2.5-3.4 kg) and 2.5 months (range 0.3-6.4 mos). All infants carried multiple diagnoses including lung disease of prematurity, swallowing dysfunction, chromosomal abnormalities, structural facial anomalies, neurological deficiencies, and congenital heart disease. PEGs were inserted with the "pull" technique using an Olympus XP20 endoscope. The infants were intubated under general anesthesia. 24 hours of perioperative IV cefazolin was given. 9 of 10 received a Surgitek 15 Fr gastrostomy tube, one a Bard 15 Fr tube. Results: No difficulties were encountered during PEG placement and no procedure was aborted. Mild skin erythema was noted at the gastrostomy site within 48 hours on two patients and these were conservatively treated with oral antibiotic therapy; there were no other complications. 50% of patients were discharged to home withing 4 days of PEG placement. 3 of 10 gastrostomy tubes were subsequently removed and replaced with low-profile devices without complications. Conclusions: PEGs can be inserted safely and effectively in very small infants. Whether PEG placement in medically complex infants can decrease hospitalization costs by allowing for earlier discharge to home needs to be explored.