Predictors of gastrostomy placement in children with inherited metabolic diseases treated by umbilical cord blood transplantation

Background/Purpose Children with inherited metabolic diseases (IMDs) undergoing umbilical cord blood transplantation (UCBT) who are at risk for post-transplant failure to thrive may benefit from pretransplant gastrostomy tube (GT) placement. Here we sought to determine predictors of posttransplant failure to thrive. Methods A retrospective analysis was performed for IMD patients who underwent UCBT at a single center from 2001 to 2011. Patients who received GTs were compared with controls. Multivariable logistic regression was used to determine significant predictors for GT placement. Recursive partitioning was performed to determine appropriate cut-offs for significant continuous variables. Results Two hundred and seventeen patients met inclusion criteria of which twenty-three were excluded due to death within one hundred days of transplant. Forty (20.6%) of the remaining patients underwent a surgical GT placement. Multivariable logistic regression demonstrated that weight percentile at time of transplant was significantly associated with GT placement (Adjusted odds ratio (AOR): 0.87 per 10th percentile, p=0.022). Recursive partitioning demonstrated that the 40th weight percentile at time of transplant was an optimal cut-off for predicting GT placement. Conclusions Patients preparing for umbilical cord transplantation who are below the 40th percentile for weight may benefit from pre-emptive GT placement prior to transplant.