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Marchese DL, Feldman K, Sinn C, Javaid S, Jaffe A, Katz E, Lider J, Green MM, Marcus L, Swanson E, Gober J, Thomas SP, Deike D, Felman K, Sinha A, Dalal P, Ewing E, Hiller A, Rosenberg N, Mosher KA, Houtrow AJ, McLaughlin MJ. Rehabilitation Outcomes in Children With Acute Flaccid Myelitis From 2014 to 2019: A Multicenter Retrospective Review. Pediatr Neurol 2023; 145:41-47. [PMID: 37271056 DOI: 10.1016/j.pediatrneurol.2023.04.027] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2022] [Revised: 02/23/2023] [Accepted: 04/30/2023] [Indexed: 06/06/2023]
Abstract
BACKGROUND Acute flaccid myelitis (AFM) is a childhood illness characterized by sudden-onset weakness impairing function. The primary goal was to compare the motor recovery patterns of patients with AFM who were discharged home or to inpatient rehabilitation. Secondary analyses focused on recovery of respiratory status, nutritional status, and neurogenic bowel and bladder in both cohorts. METHODS Eleven tertiary care centers in the United States performed a retrospective chart review of children with AFM between January 1, 2014, and October 1, 2019. Data included demographics, treatments, and outcomes on admission, discharge, and follow-up visits. RESULTS Medical records of 109 children met inclusion criteria; 67 children required inpatient rehabilitation, whereas 42 children were discharged directly home. The median age was 5 years (range 4 months to 17 years), and the median time observed was 417 days (interquartile range = 645 days). Distal upper extremities recovered better than the proximal upper extremities. At acute presentation, children who needed inpatient rehabilitation had significantly higher rates of respiratory support (P < 0.001), nutritional support (P < 0.001), and neurogenic bowel (P = 0.004) and bladder (P = 0.002). At follow-up, those who attended inpatient rehabilitation continued to have higher rates of respiratory support (28% vs 12%, P = 0.043); however, the nutritional status and bowel/bladder function were no longer statistically different. CONCLUSIONS All children made improvements in strength. Proximal muscles remained weaker than distal muscles in the upper extremities. Children who qualified for inpatient rehabilitation had ongoing respiratory needs at follow-up; however, recovery of nutritional status and bowel/bladder were similar.
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Affiliation(s)
- Diana L Marchese
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Children's Mercy-Kansas City, Kansas City, Missouri.
| | - Keith Feldman
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Children's Mercy-Kansas City, Kansas City, Missouri
| | - Clarice Sinn
- Division of Pediatric Physical Medicine and Rehabilitation, Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Children's Health Dallas, Dallas, Texas
| | - Simra Javaid
- Division of Pediatric Physical Medicine and Rehabilitation, Department of Physical Medicine and Rehabilitation, UT Southwestern Medical Center, Children's Health Dallas, Dallas, Texas
| | - Ashlee Jaffe
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Elana Katz
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | - Joshua Lider
- University of Utah/Primary Children's Hospital, Salt Lake City, Utah
| | - Michael M Green
- University of Utah/Primary Children's Hospital, Salt Lake City, Utah
| | - Lydia Marcus
- Division of Pediatric Neurology, University of Alabama at Birmingham, Birmingham, Alabama
| | - Erin Swanson
- Division of Pediatric Rehabilitation Medicine, University of Alabama at Birmingham, Children's of Alabama, Birmingham, Alabama
| | - Joslyn Gober
- Department of Physical Medicine and Rehabilitation, Miller School of Medicine, University of Miami, Miami, Florida
| | - Sruthi P Thomas
- Department of Physical Medicine and Rehabilitation, Baylor College of Medicine, Houston, Texas
| | - Dawn Deike
- Department of Physical Medicine and Rehabilitation, Northwestern University, Chicago, Illinois
| | - Kristyn Felman
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Amit Sinha
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Pritha Dalal
- Division of Pediatric Rehabilitation Medicine, Rady Children's Hospital San Diego, San Diego, California
| | - Emily Ewing
- Division of Pediatric Rehabilitation Medicine, Rady Children's Hospital San Diego, San Diego, California
| | - Amy Hiller
- Department of Physical Medicine and Rehabilitation, Nationwide Children's Hospital, Columbus, Ohio
| | - Nathan Rosenberg
- Department of Physical Medicine and Rehabilitation, Nationwide Children's Hospital, Columbus, Ohio
| | - Kathryn A Mosher
- Akron Children's Hospital, NeuroDevelopmental Science Center, Akron, Ohio
| | - Amy J Houtrow
- Department of Physical Medicine and Rehabilitation, University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania
| | - Matthew J McLaughlin
- Department of Pediatrics, University of Missouri-Kansas City School of Medicine, Kansas City, Missouri; Children's Mercy-Kansas City, Kansas City, Missouri
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O'Brien K, Scaife J, Iantorno S, Bucher B. Caregiver health-related quality of life 1 year following pediatric gastrostomy tube placement. Surg Open Sci 2022; 10:111-115. [PMID: 36118361 PMCID: PMC9474284 DOI: 10.1016/j.sopen.2022.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/29/2022] [Accepted: 08/15/2022] [Indexed: 11/20/2022] Open
Affiliation(s)
- Karlie O'Brien
- University of Utah School of Medicine, Salt Lake City, UT, USA
- Corresponding author at: University of Utah School of Medicine, 30 N 1900 E, Salt Lake City, UT 84132. Tel.: + 1 (801)-879-7901.
| | - Jack Scaife
- University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Stephanie Iantorno
- Division of Pediatric Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
| | - Brian Bucher
- Division of Pediatric Surgery, Department of Surgery, University of Utah, Salt Lake City, UT, USA
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Jackson JE, Theodorou CM, Vukcevich O, Brown EG, Beres AL. Patient selection for pediatric gastrostomy tubes: Are we placing tubes that are not being used? J Pediatr Surg 2022; 57:532-537. [PMID: 34229875 DOI: 10.1016/j.jpedsurg.2021.06.001] [Citation(s) in RCA: 4] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/23/2021] [Revised: 04/12/2021] [Accepted: 06/04/2021] [Indexed: 11/18/2022]
Abstract
INTRODUCTION Identifying pediatric patients who may benefit from gastrostomy tube (GT) placement can be challenging. We hypothesized that many GTs would no longer be in use after 6 months. METHODS Inpatient GT placements in patients < 18 years old at a tertiary children's hospital from 9/2014 to 2/2020 were included. The primary outcome was GT use <6 months (short-term). Secondary outcomes included age at placement, indication for GT, and operations for GT-related issues. RESULTS Fifteen percent (22/142) of GTs were used for <6 months post-operatively. The median duration of short-term GT use was 1.6 months (IQR 0.9-3.4 months). Short-term GTs were more likely to be placed in patients with traumatic brain injury (TBI) (18.2% vs. 4.2%, p = 0.03) and adolescents (≥12 years old, 22.7% vs. 4.0%, p = 0.005). Gastrocutaneous fistula closure was required in 33.3% of short-term patients who had their GTs removed (n = 6/18), with median total hospital charges of $29,989 per patient. CONCLUSION Fifteen percent of pediatric GTs placed as inpatients were used for <6 months, more commonly among adolescents and in TBI patients. One-third of patients with short-term GTs required gastrocutaneous fistula closure. Adolescents and TBI patients may benefit from consideration of short-term nasogastric tube (NGT) feeds rather than surgical GT placement. LEVEL OF EVIDENCE III.
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Affiliation(s)
- Jordan E Jackson
- University of California-Davis, Department of Surgery, Sacramento, CA, USA.
| | | | - Olivia Vukcevich
- University of California-Davis, Department of Surgery, Sacramento, CA, USA
| | - Erin G Brown
- University of California-Davis, Department of Surgery, Sacramento, CA, USA
| | - Alana L Beres
- University of California-Davis, Department of Surgery, Sacramento, CA, USA
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Weight gain and resource utilization in infants after fundoplication versus gastrojejunostomy. Pediatr Surg Int 2022; 38:485-492. [PMID: 34988651 DOI: 10.1007/s00383-021-05031-9] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 10/09/2021] [Indexed: 10/19/2022]
Abstract
PURPOSE There is wide practice variation in the use of laparoscopic fundoplication (LF) versus gastrojejunostomy (GJ) tube insertion for children who do not tolerate gastric feeds. Using weight gain as an objective proxy of adequate nutrition, we sought to evaluate the difference in weight gain between LF and GJ. METHODS A retrospective, cohort study was conducted of patients ≤ 2 years who underwent LF or GJ between 2014 and 2019 at a single institution. Patient characteristics, change in weight 1-year post-procedure and frequency of unplanned healthcare utilization encounters were collected and examined. RESULTS A total of 125 patients (50.4%LF, 49.6%GJ) were identified. Adjusted modeling demonstrated that on average, there was an additional 0.85-unit increase in weight-for-age Z scores in the LF compared to the GJ cohort (p = 0.01). The GJ cohort had significantly more unplanned healthcare utilization encounters (4.2, SD 3.4) compared to LF (3.0, SD 3.1) (p = 0.03). Furthermore, the GJ cohort underwent an average of 3.3 planned GJ exchanges within 1-year post-procedure. CONCLUSION In the first year post-operatively, LF is associated with increased weight gain and fewer unplanned and overall healthcare encounters compared to GJ. Long-term outcomes including weight gain and quality-of-life measures should be studied to develop standardized guidelines for this common clinical scenario.
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Abstract
BACKGROUND The European Society for Paediatric Gastroenterology, Hepatology, and Nutrition (ESPGHAN) position paper from 2015 on percutaneous endoscopic gastrostomy (PEG) required updating in the light of recent clinical knowledge and data published in medical journals since 2014. METHODS A systematic review of medical literature from 2014 to 2020 was carried out. Consensus on the content of the manuscript, including recommendations, was achieved by the authors through electronic and virtual means. The expert opinion of the authors is also expressed in the manuscript when there was a lack of good scientific evidence regarding PEGs in children in the literature. RESULTS The authors recommend that the indication for a PEG be individualized, and that the decision for PEG insertion is arrived at by a multidisciplinary team (MDT) having considered all appropriate circumstances. Well timed enteral nutrition is optimal to treat faltering growth to avoid complications of malnutrition and body composition. Timing, device choice and method of insertion is dependent on the local expertise and after due consideration with the MDT and family. Major complications such as inadvertent bowel perforation should be avoided by attention to good technique and by ensuring the appropriate experience of the operating team. Feeding can be initiated as early as 3 hours after tube placement in a stable child with iso-osmolar feeds of standard polymeric formula. Low-profile devices can be inserted initially using the single-stage procedure or after 2-3 months by replacing a standard PEG tube, in those requiring longer-term feeding. Having had a period of non-use and reliance upon oral intake for growth and weight gain-typically 8-12 weeks-a PEG may then safely be removed after due consultation. In the event of non-closure of the fistula the most successful method for closing it, to date, has been a surgical procedure, but the Over-The-Scope-Clip (OTSC) has recently been used with considerable success in this scenario. CONCLUSIONS A multidisciplinary approach is mandatory for the best possible treatment of children with PEGs. Morbidity and mortality are minimized through team decisions on indications for insertion, adequate planning and preparation before the procedure, subsequent monitoring of patients, timing of the change to low-profile devices, management of any complications, and optimal timing of removal of the PEG.
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