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Prakash J, Pardy C, Yardley I, Kelly V. Psychological and social impacts on carers of children with a gastrostomy: a systematic review. Pediatr Surg Int 2024; 40:44. [PMID: 38294568 DOI: 10.1007/s00383-023-05618-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 12/15/2023] [Indexed: 02/01/2024]
Abstract
To determine the psychological and social impacts of a gastrostomy in childhood on carers and families. A systematic search of OVID, Medline and Embase was undertaken using the subject headings and word variants for 'gastrostomy', 'children' and 'carers'. Studies included were those describing the impact of gastrostomies in children on family and carers, published in English. 564 articles were identified. After exclusion of duplicates, abstract and full text screening, 25 were included. Carer anxiety increases in the period leading up to, and for a short period following gastrostomy insertion. 3-6 months following gastrostomy insertion, anxiety reduced (reduced State-Trait Anxiety Inventory scores), carer quality of life improved (higher Quality of Life Scale scores), and carer satisfaction with the child's gastrostomy increased (improved Satisfaction Questionnaire with Gastrostomy Feeding scores). Reported changes in carer quality of life in the longer term following a child's gastrostomy insertion were mixed. The social and psychological burden on caregivers of a gastrostomy in childhood varies over time. There is evidence that paediatric gastrostomies have positive effects on carers' psychological and social well-being; however, aspects of carers' quality of life remain impaired. Carer education and support are vital to reduce the burden placed on carers.
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Affiliation(s)
- Joe Prakash
- GKT King's College London Medical School, London, UK
| | - Caroline Pardy
- Department of Paediatric Surgery, Evelina London Children's Hospital, London, SE1 7EH, UK.
| | - Iain Yardley
- GKT King's College London Medical School, London, UK
- Department of Paediatric Surgery, Evelina London Children's Hospital, London, SE1 7EH, UK
| | - Veronica Kelly
- Childrens Health Ireland, Herberton, St James's Walk, Rialto, D08 HP97, Ireland
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Grunewald W, Smith AR, Brown TA. Treatment of avoidant-restrictive food intake disorder in an older adult: A proof-of-concept case study. Int J Eat Disord 2023; 56:1795-1800. [PMID: 37097823 DOI: 10.1002/eat.23973] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/06/2023] [Revised: 04/13/2023] [Accepted: 04/13/2023] [Indexed: 04/26/2023]
Abstract
OBJECTIVE Cognitive behavioral therapy for Avoidant Restrictive Food Intake Disorder (ARFID; CBT-AR) is an emerging treatment for ARFID. However, this treatment modality has yet to be examined among older adults (e.g., older than 50 years) or with adults presenting with feeding tubes. To inform future versions of CBT-AR, we present the results of a singular case study (G) of an older male with the sensory sensitivity phenotype of ARFID who presented for treatment with a gastrostomy tube. METHODS G was a 71-year-old male who completed eight sessions of CBT-AR in a doctoral training clinic. ARFID symptom severity and comorbid eating pathology changes were examined pre- and post-treatment. RESULTS Posttreatment, G reported significant decreases in ARFID symptom severity and no longer met diagnostic criteria for ARFID. Furthermore, throughout treatment, G reported significant increases in his oral food consumption (vs. calories being pushed through the feeding tube), solid food consumption, and the feeding tube was ultimately removed. DISCUSSION This study provides proof of concept that CBT-AR is potentially effective for older adults and/or those presenting for treatment with feeding tubes. Validation of patient efforts and severity of ARFID symptoms emerged as core to treatment success and should be emphasized when training clinicians in CBT-AR. PUBLIC SIGNIFICANCE Cognitive behavior therapy for ARFID (CBT-AR) is the leading treatment for this disorder; however, it has yet to be tested among older adults or those with feeding tubes. This single-patient case study demonstrates that CBT-AR may be efficacious in reducing ARFID symptom severity among older adults with a feeding tube.
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Affiliation(s)
- William Grunewald
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
| | - April R Smith
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
| | - Tiffany A Brown
- Department of Psychological Sciences, Auburn University, Auburn, Alabama, USA
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3
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Nelson KE, Finlay M, Huang E, Chakravarti V, Feinstein JA, Diskin C, Thomson J, Mahant S, Widger K, Feudtner C, Cohen E. Clinical characteristics of children with severe neurologic impairment: A scoping review. J Hosp Med 2023; 18:65-77. [PMID: 36484088 PMCID: PMC9829450 DOI: 10.1002/jhm.13019] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/11/2022] [Revised: 10/21/2022] [Accepted: 11/16/2022] [Indexed: 12/13/2022]
Abstract
OBJECTIVE The aim of this study is to extrapolate the clinical features of children with severe neurologic impairment (SNI) based on the functional characteristics and comorbidities described in published studies. METHODS Four databases were searched. We included studies that describe clinical features of a group of children with SNI (≥20 subjects <19 years of age with >1 neurologic diagnosis and severe functional limitation) using data from caregivers, medical charts, or prospective collection. Studies that were not written in English were excluded. We extracted data about functional characteristics, comorbidities, and study topics. RESULTS We included 102 studies, spanning 5 continents over 43 years, using 41 distinct terms for SNI. The terms SNI and neurologic impairment (NI) were used in 59 studies (58%). Most studies (n = 81, 79%) described ≥3 types of functional characteristics, such as technology assistance and motor impairment. Studies noted 59 comorbidities and surgeries across 10 categories. The most common comorbidities were related to feeding, nutrition, and the gastrointestinal system, which were described in 79 studies (77%). Most comorbidities (76%) were noted in <10 studies. Studies investigated seven clinical topics, with "Gastrointestinal reflux and feeding tubes" as the most common research focus (n = 57, 56%). The next most common topic, "Aspiration and respiratory issues," included 13 studies (13%). Most studies (n = 54, 53%) were retrospective cohorts or case series; there were no clinical trials. CONCLUSIONS Despite the breadth of described comorbidities, studies focused on a narrow set of clinical topics. Further research is required to understand the prevalence, clinical impact, and interaction of the multiple comorbidities that are common in children with SNI.
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Affiliation(s)
- Katherine E Nelson
- Pediatric Advanced Care Team, Hospital for Sick Children, Toronto, Ontario, Canada
- Department of Paediatrics, Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
| | - Melissa Finlay
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Emma Huang
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - Vishakha Chakravarti
- Pediatric Advanced Care Team, Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
| | - James A Feinstein
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado and Children's Hospital Colorado, Aurora, Colorado, USA
| | - Catherine Diskin
- Department of Paediatrics, Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
| | - Joanna Thomson
- Department of Pediatrics, University of Cincinnati College of Medicine, Cincinnati, Ohio, USA
- Division of Hospital Medicine, Cincinnati Children's Hospital Medical Center, Cincinnati, Ohio, USA
| | - Sanjay Mahant
- Department of Paediatrics, Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada
| | - Kimberley Widger
- Pediatric Advanced Care Team, Hospital for Sick Children, Toronto, Ontario, Canada
- Lawrence S. Bloomberg Faculty of Nursing, University of Toronto, Toronto, Ontario, Canada
| | - Chris Feudtner
- The Justin Michael Ingerman Center for Palliative Care, Children's Hospital of Philadelphia, Philadelphia, Pennsylvania, USA
- Departments of Pediatrics and Medical Ethics and Health Policy, Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pennsylvania, USA
| | - Eyal Cohen
- Department of Paediatrics, Division of Paediatric Medicine, Hospital for Sick Children, Toronto, Ontario, Canada
- Child Health Evaluative Sciences, SickKids Research Institute, Toronto, Ontario, Canada
- Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
- Institute for Health Policy, Management and Evaluation, Dalla Lana School of Public Health, University of Toronto, Toronto, Ontario, Canada
- Adult and Child Consortium for Health Outcomes Research and Delivery Science, University of Colorado and Children's Hospital Colorado, Aurora, Colorado, USA
- Edwin S.H. Leong Centre for Healthy Children, University of Toronto, Toronto, Ontario, Canada
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Lin JL, Rigdon J, Van Haren K, Buu M, Saynina O, Bhattacharya J, Owens DK, Sanders LM. Gastrostomy Tubes Placed in Children With Neurologic Impairment: Associated Morbidity and Mortality. J Child Neurol 2021; 36:727-734. [PMID: 33750232 DOI: 10.1177/08830738211000179] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND Gastrostomy tube (G-tube) placement for children with neurologic impairment with dysphagia has been suggested for pneumonia prevention. However, prior studies demonstrated an association between G-tube placement and increased risk of pneumonia. We evaluate the association between timing of G-tube placement and death or severe pneumonia in children with neurologic impairment. METHODS We included all children enrolled in California Children's Services between July 1, 2009, and June 30, 2014, with neurologic impairment and 1 pneumonia hospitalization. Prior to analysis, children with new G-tubes and those without were 1:2 propensity score matched on sociodemographics, medical complexity, and severity of index hospitalization. We used a time-varying Cox proportional hazard model for subsequent death or composite outcome of death or severe pneumonia to compare those with new G-tubes vs those without, adjusting for covariates described above. RESULTS A total of 2490 children met eligibility criteria, of whom 219 (9%) died and 789 (32%) had severe pneumonia. Compared to children without G-tubes, children with new G-tubes had decreased risk of death (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.39-0.55) but increased risk of the composite outcome (HR 1.21, CI 1.14-1.27). Sensitivity analyses using varied time criteria for definitions of G-tube and outcome found that more recent G-tube placement had greater associated risk reduction for death but increased risk of severe pneumonia. CONCLUSION Recent G-tube placement is associated with reduced risk of death but increased risk of severe pneumonia. Decisions to place G-tubes for pulmonary indications in children with neurologic impairment should weigh the impact of severe pneumonia on quality of life.
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Affiliation(s)
- Jody L Lin
- Division of Pediatric Hospital Medicine, Department of Pediatrics, 14434University of Utah School of Medicine, Salt Lake City, UT, USA
| | - Joseph Rigdon
- Department of Biostatistics and Data Science, 12279Wake Forest School of Medicine, Winston-Salem, NC, USA
| | - Keith Van Haren
- Division of Child Neurology, Department of Neurology and Neurological Science, 10624Stanford University School of Medicine, Stanford, CA, USA
| | - MyMy Buu
- Division of Pediatric Pulmonary Medicine, Department of Pediatrics, 10624Stanford University School of Medicine, Stanford, CA, USA
| | - Olga Saynina
- Division of General Pediatrics, Department of Pediatrics, 10624Stanford University School of Medicine, Stanford, CA, USA
| | - Jay Bhattacharya
- Stanford Health Policy, 166495Stanford University, Stanford, CA, USA
| | - Douglas K Owens
- Stanford Health Policy, 166495Stanford University, Stanford, CA, USA.,VA Palo Alto Health Care System, Palo Alto, CA, USA
| | - Lee M Sanders
- Division of General Pediatrics, Department of Pediatrics, 10624Stanford University School of Medicine, Stanford, CA, USA
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Hopwood N, Moraby K, Dadich A, Gowans J, Pointon K, Ierardo A, Reilly C, Syrmis M, Frederiksen N, Disher-Quill K, Scheuring N, Heves R, Elliot C. Paediatric tube-feeding: An agenda for care improvement and research. J Paediatr Child Health 2021; 57:182-187. [PMID: 33277951 DOI: 10.1111/jpc.15286] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/21/2020] [Revised: 10/21/2020] [Accepted: 11/17/2020] [Indexed: 12/14/2022]
Abstract
This article presents an agenda to improve the care and wellbeing of children with paediatric feeding disorder who require tube feeding (PFD-T). PFD-T requires urgent attention in practice and research. Priorities include: routine collection of PFD-T data in health-care records; addressing the tube-feeding lifecycle; and reducing the severity and duration of disruption caused by PFD-T where possible. This work should be underpinned by principles of involving, respecting and connecting families.
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Affiliation(s)
- Nick Hopwood
- School of International Studies and Education, University of Technology Sydney, Broadway, New South Wales, Australia.,Department of Curriculum Studies, University of Stellenbosch, Stellenbosch, South Africa
| | - Khadeejah Moraby
- Central Early Childhood and Families Service, Allied Health, Women's and Children's Health Network, Adelaide, South Australia, Australia
| | - Ann Dadich
- School of Business, Western Sydney University, Sydney, New South Wales, Australia
| | - Jessica Gowans
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Keren Pointon
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Anna Ierardo
- Department of Paediatrics, St George Hospital, Sydney, New South Wales, Australia
| | - Claire Reilly
- Child Health Research Centre, University of Queensland, Brisbane, Queensland, Australia
| | - Maryanne Syrmis
- Speech Pathology Department, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Nadine Frederiksen
- Department of Occupational Therapy and Music Therapy, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Kate Disher-Quill
- Department of Paediatrics, St George Hospital, Sydney, New South Wales, Australia
| | - Noémi Scheuring
- Department of Pediatrics, Heim Pál National Institute of Pediatrics, Budapest, Hungary
| | - Rudolf Heves
- Educational Technology, Web-Medu Health and Lifestyle Consulting Private Limited Company (Member of Rufusz Group), Budapest, Hungary
| | - Chris Elliot
- Department of Paediatrics, St George Hospital, Sydney, New South Wales, Australia.,Department of Community Child Health, Sydney Children's Hospital Randwick, Sydney, New South Wales, Australia.,School of Women's and Children's Health, University of New South Wales, Sydney, New South Wales, Australia
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6
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Craig GM, Hajdukova EB, Harding C, Flood C, McCourt C, Sellers D, Townsend J, Moss D, Tuffrey C, Donaldson B, Cole M, Gill A. Psychosocial support for families of children with neurodisability who have or are considering a gastrostomy: the G-PATH mixed-methods study. HEALTH SERVICES AND DELIVERY RESEARCH 2020. [DOI: 10.3310/hsdr08380] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023] Open
Abstract
Background
Evidence reviews recommend consistent and structured support for children with neurodisability and their caregivers in care pathways in which professionals recommend a gastrostomy feeding tube. To date, and to our knowledge, no research has shown how these recommendations have been implemented.
Objectives
The objectives were to describe different exemplar models of psychosocial support and provide an estimate of their resources and costs.
Design
This was a mixed-methods study involving (1) a web-based survey, (2) a qualitative, collective case study of psychosocial support provision in four services and (3) an estimate of costs and preference through a willingness-to-pay study.
Setting
Four service configurations in different locations in England and Scotland.
Participants
Participants were staff who responded to a survey (n = 67) and interviewees (staff, n = 58; parents/children, n = 29).
Findings
Psychosocial support was rarely formalised or documented; it was delivered by different members of the multidisciplinary team, rather than by designated staff, and it was often integrated into appointments dominated by clinical care. Parents expressed different needs for support but reported little opportunity to discuss emotional aspects. Psychologists were not routinely involved and, in general, families were underserved by psychosocial services. Professionals constructed families’ need for psychosocial support in terms of their own roles and the management of risk. Mechanisms for integrating and delivering support were identified, including models of care that linked community and tertiary health services and integrated health and education through pooled budgets. Although generally valued by both staff and parents, peer-to-peer parent support was not consistently offered. Barriers included concerns about confidentiality and appropriately matching parents. Parents participated as members of a feeding committee at one site. Three analytical constructs described the provision of psychosocial support: ‘hidden work’, expressing emotional vulnerability and negotiations around risks and values. The cost-of-support study found that there was a mean of 2.25 appointments (n = 8 parents or carers) over the previous 12 months. The cost of health-care professionals’ time spent on providing psychosocial support ranged from £0.00 to £317.37 per child per year, with an average cost of £76.42, at 2017 prices. In the willingness-to-pay study the median rank of enhanced support, involving the opportunity to see a psychologist and parental peers, was significantly higher than that of usual care (n = 96 respondents, both carers and professionals, who completed rating of the service; p < 0.001).
Limitations
It proved difficult to disseminate a national survey, which resulted in a small number of returns, and to cost the provision of psychosocial support, which we designated as ‘hidden work’, owing to the lack of recording in clinical systems. Moreover, estimates were based on small numbers.
Conclusions
Parent interviews and the willingness-to-pay study demonstrated a preference for enhanced psychosocial support. The study suggests that there is a need for services to formally assess families’ needs for psychosocial support to ensure that provision is planned, costed and made explicit in care pathways. Personalised interventions may assist with the targeting of resources and ensuring that there is an appropriate balance in focus on both clinical care and psychosocial support needs in relation to and following treatment.
Future work
More work is needed to develop tools to assess families’ needs for psychosocial support and the effectiveness of training packages to strengthen team competency in providing support.
Funding
This project was funded by the National Institute for Health Research (NIHR) Health Services and Delivery Research programme and will be published in full in Health Services and Delivery Research; Vol. 8, No. 38. See the NIHR Journals Library website for further project information.
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Affiliation(s)
- Gillian M Craig
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
- School of Health Sciences, City, University of London, London, UK
| | - Eva Brown Hajdukova
- Centre for Research in Public Health and Community Care, University of Hertfordshire, Hatfield, UK
| | - Celia Harding
- School of Health Sciences, City, University of London, London, UK
| | - Chris Flood
- School of Health Sciences, City, University of London, London, UK
| | | | - Diane Sellers
- Brighton and Sussex University Hospitals NHS Trust, Brighton, UK
| | - Joy Townsend
- Department of Social and Environmental Health Research, London School of Hygiene & Tropical Medicine, London, UK
| | - Dawn Moss
- Borders General Hospital, Melrose, UK
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Puia-Dumitrescu M, Benjamin DK, Smith PB, Greenberg RG, Abuzaid N, Andrews W, Chellani K, Gupta A, Price D, Williams C, Malcolm WF, Clark RH, Zimmerman KO. Impact of Gastrostomy Tube Placement on Short-Term Weight Gain in Hospitalized Premature Infants. JPEN J Parenter Enteral Nutr 2020; 44:355-360. [PMID: 30908714 PMCID: PMC7295029 DOI: 10.1002/jpen.1539] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2018] [Revised: 02/25/2019] [Accepted: 03/08/2019] [Indexed: 11/09/2022]
Abstract
BACKGROUND Gastrostomy tube (G-tube) placement is a long-term alternative to oral or nasogastric feeding for premature infants who cannot safely feed orally or need supplemental nutrition for adequate growth. METHODS We compared daily weight changes for G-tube infants 14 and 30 days preplacement and postplacement, excluding the first 7 days post-G-tube insertion. Infants <37 weeks of gestation without major congenital anomalies and discharged from 327 United States neonatal intensive care units (2004-2013) were included. Incidence of in-hospital outcomes including hypoxic ischemic encephalopathy, intraventricular hemorrhage grade 3 or 4, necrotizing enterocolitis, and patent ductus arteriosus ligation was examined. Additionally, we estimated a treatment effect model in which infants with a G-tube were matched 1:1 to untreated controls based on propensity scores; main outcome was the average treatment effect (weight gain) for treated infants during the 7, 14, or 30 days immediately prior to discharge. RESULTS Of 329,254 infants, 1393 (0.4%) received a G-tube, increasing from 0.2% in 2004 to 0.6% in 2013. Daily weight gain was significantly less during days 8-14 postplacement compared with 14 days preplacement but was similar between 30 days preplacement and 8-30 days postplacement. After matching, G-tube infant weight gain during the 7 days predischarge was less than among controls, but there was no difference in weight gain between treated and control patients for 14 days and 30 days predischarge. CONCLUSIONS The prevalence of G-tube placement has increased. G-tube use in infants was not associated with improved short-term daily weight gain.
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Affiliation(s)
- Mihai Puia-Dumitrescu
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
| | - Daniel K Benjamin
- Department of Economics, Clemson University, Clemson, South Carolina, USA
| | - P Brian Smith
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Rachel G Greenberg
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Nada Abuzaid
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Winsome Andrews
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Kris Chellani
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Anjali Gupta
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Douglas Price
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - Ciara Williams
- Duke Clinical Research Institute, Durham, North Carolina, USA
| | - William F Malcolm
- Department of Pediatrics, University of Washington, Seattle, Washington, USA
| | - Reese H Clark
- Pediatrix-Obstetrix Center for Research and Education, Sunrise, Florida, USA
| | - Kanecia O Zimmerman
- Department of Pediatrics, Duke University Medical Center, Durham, North Carolina, USA
- Duke Clinical Research Institute, Durham, North Carolina, USA
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Cass H. Gastrostomy in children with neurological impairments: many a slip twixt tube and lip. Dev Med Child Neurol 2020; 62:156. [PMID: 31418817 DOI: 10.1111/dmcn.14335] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Affiliation(s)
- Hilary Cass
- Evelina London Children's Hospital, London, UK
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9
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Franken J, Stellato RK, Tytgat SHAJ, Van der Zee DC, Mauritz FA, Lindeboom MYA. Gastro-esophageal Reflux After Laparoscopic Gastrostomy Placement in Children. J Pediatr Gastroenterol Nutr 2020; 70:e41-e47. [PMID: 31978032 DOI: 10.1097/mpg.0000000000002530] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Gastrostomy placement is frequently performed in pediatric patients who require long-term enteral tube feeding. Evidence on the influence of gastrostomy placement on gastro-oesophageal reflux disease has been inconsistent. The aim of this study was to investigate the influence of gastrostomy on gastro-oesophageal reflux. METHODS A prospective, longitudinal cohort study was performed including 50 patients who underwent laparoscopic gastrostomy between May 2012 and April 2014. Before and 3 months after surgery 24-hour multichannel intraluminal impedance pH monitoring was performed and caregivers filled out reflux symptom questionnaires. RESULTS Gastro-oesophageal reflux symptoms were present in a comparable number of patients before (44%) and after gastrostomy placement (40%; P = 0.73). Twenty-five of the patients (50%) underwent both the preoperative and postoperative tests and were included in impedance-pH analysis. Acid exposure time (percentage of time with pH below 4) did not change significantly after gastrostomy placement: from 6.2% (3.0-18.1) to 6.1% (2.6-14.9). The number of reflux episodes did not significantly change, for either liquid [mean difference 4.3 (-4.5 to 13.2)] or mixed liquid-gas reflux [mean difference 2.0 (-9.3 to 13.3)]. Before gastrostomy placement, 18 out of 25 patients had pathological reflux (72%) on pH-impedance measurement. In 4 patients, pathological reflux dissolved, whereas 4 patients newly developed pathological reflux. A low preoperative weight-for-height percentile was associated with increased acid exposure after gastrostomy placement. CONCLUSIONS Overall, gastrostomy placement was not associated with an increase in acid exposure on 24-hour multichannel intraluminal impedance pH monitoring. Similarly, the prevalence of gastro-oesophageal reflux-related symptoms did not change after gastrostomy.
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Affiliation(s)
- Josephine Franken
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht
| | - Rebecca K Stellato
- Department of Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Utrecht, The Netherlands
| | - Stefaan H A J Tytgat
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht
| | - David C Van der Zee
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht
| | - Femke A Mauritz
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht
| | - Maud Y A Lindeboom
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht
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10
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Franken J, Stellato RK, Tytgat SHAJ, van der Zee DC, Mauritz FA, Lindeboom MYA. The Effect of Gastrostomy Placement on Health-Related Quality of Life in Children. J Pediatr Surg 2019; 54:2268-2273. [PMID: 31303329 DOI: 10.1016/j.jpedsurg.2019.05.026] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/15/2018] [Revised: 05/18/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
Abstract
BACKGROUND AND PURPOSE A gastrostomy placement (GP) aims to improve nutritional status and health-related quality of life (HRQoL) in children who require long-term enteral tube feeding. We evaluated the effect of GP on HRQoL. METHODS A prospective, longitudinal cohort study was performed including patients referred for laparoscopic GP. Children and/or caregivers were asked to fill out the validated PedsQL™ questionnaire before and 3 months after surgery. The aim was to compare preoperative with postoperative HRQoL and to identify predictors of HRQoL. RESULTS Fifty patients were included with a median age of 3.4 years (interquartile range 1.4-5.6). After GP, total HRQoL did not significantly increase (p = 0.30). However, psychosocial health significantly increased: 55.8 (standard deviation ±20.8) to 61.2 (±19.6; p = 0.03) on a 100-point scale. This was mainly owing to an increase in social HRQoL: 58.2 (±32.3) to 68.3 (±27.9; p = 0.04). HRQoL both before and after GP was significantly lower in children with neurologic impairment (p < 0.0005). However, neurologic impairment did not influence the effect of surgery on HRQoL (p = 0.66). Low preoperative body mass index was a predictor for improvement in HRQoL after GP. CONCLUSIONS After GP in children, psychosocial HRQoL improved significantly. This was mainly owing to an improvement in social HRQoL. LEVEL OF EVIDENCE IV.
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Affiliation(s)
- Josephine Franken
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands.
| | - Rebecca K Stellato
- Department of Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, The Netherlands
| | - Stefaan H A J Tytgat
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - David C van der Zee
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Femke A Mauritz
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands
| | - Maud Y A Lindeboom
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, The Netherlands.
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Franken J, Stellato RK, Tytgat SHAJ, van der Zee DC, Mauritz FA, Lindeboom MYA. Health-related quality of life in children after laparoscopic gastrostomy placement. Qual Life Res 2019; 29:171-178. [PMID: 31420828 PMCID: PMC6962119 DOI: 10.1007/s11136-019-02272-z] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 08/09/2019] [Indexed: 12/29/2022]
Abstract
Introduction A gastrostomy placement (GP) is an established treatment to provide enteral feeding in pediatric patients with feeding difficulties aiming to improve nutritional status and health-related quality of life (HRQoL). The aim of this study was to evaluate HRQoL in children with severe feeding difficulties who have undergone GP. Materials and methods A cross-sectional study was performed including 128 patients who had undergone laparoscopic GP (2004–2011). HRQoL was evaluated using the validated Pediatric Quality of Life 4.0 Inventory. Multiple regression analysis was performed to identify predictors of HRQoL. Results After a mean follow-up of 4.0 years (interquartile range 2.9–6.2) after GP, mean HRQoL was 53.0 out of 100 (standard deviation 21.1). HRQoL was significantly lower in children with neurologic impairment, with a mean difference of −21.4 points between neurologically impaired and neurologically normal children (p < 0.001). HRQoL was also lower in children with cardiac disease (−19.0 points; p = 0.01) and in children with a history of previous gastrointestinal surgery (−15.2 points; p = 0.03). Feeding through a gastrojejunostomy tube (−33.0 points; p = 0.01) and higher age at the time of operation (−1.2 points per year; p = 0.03) were also associated with lower HRQoL. GP-related complications requiring reintervention were associated with lower HRQoL, although this association was not statistically significant (p = 0.06). Conclusions Children with severe feeding difficulty, who have undergone GP, have significantly lower HRQoL compared to a healthy pediatric population. Neurologic impairment, cardiac disease, a history of gastrointestinal surgery, older age, and the need for jejunal feeding through the gastrostomy were predictive of even lower HRQoL.
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Affiliation(s)
- Josephine Franken
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - Rebecca K Stellato
- Department of Biostatistics, Julius Center for Health Sciences and Primary Care, University Medical Center Utrecht, Heidelberglaan 100, 3584 CX, Utrecht, The Netherlands
| | - Stefaan H A J Tytgat
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - David C van der Zee
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - Femke A Mauritz
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands
| | - Maud Y A Lindeboom
- Department of Pediatric Surgery, Wilhelmina Children's Hospital, University Medical Center Utrecht, Lundlaan 6, 3584 EA, Utrecht, The Netherlands.
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The Use of Jejunal Tube Feeding in Children: A Position Paper by the Gastroenterology and Nutrition Committees of the European Society for Paediatric Gastroenterology, Hepatology, and Nutrition 2019. J Pediatr Gastroenterol Nutr 2019; 69:239-258. [PMID: 31169666 DOI: 10.1097/mpg.0000000000002379] [Citation(s) in RCA: 13] [Impact Index Per Article: 2.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/07/2023]
Abstract
OBJECTIVES Jejunal tube feeding (JTF) is increasingly becoming the standard of care for children in whom gastric tube feeding is insufficient to achieve caloric needs. Given a lack of a systematic approach to the care of JTF in paediatric patients, the aim of this position paper is to provide expert guidance regarding the indications for its use and practical considerations to optimize its utility and safety. METHODS A group of members of the Gastroenterology and Nutrition Committees of the European Society of Paediatric Gastroenterology Hepatology and Nutrition and of invited experts in the field was formed in September 2016 to produce this clinical guide. Seventeen clinical questions treating indications and contraindications, investigations before placement, techniques of placement, suitable feeds and feeding regimen, weaning from JTF, complications, long-term care, and ethical considerations were addressed.A systematic literature search was performed from 1982 to November 2018 using PubMed, the MEDLINE, and Cochrane Database of Systematic Reviews. Grading of Recommendations, Assessment, Development, and Evaluation was applied to evaluate the outcomes.During a consensus meeting, all recommendations were discussed and finalized. In the absence of evidence from randomized controlled trials, recommendations reflect the expert opinion of the authors. RESULTS A total of 33 recommendations were voted on using the nominal voting technique. CONCLUSIONS JTF is a safe and effective means of enteral feeding when gastric feeding is insufficient to meet caloric needs or is not possible. The decision to place a jejunal tube has to be made by close cooperation of a multidisciplinary team providing active follow-up and care.
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Martínez-Costa C, Calderón C, Gómez-López L, Borraz S, Crehuá-Gaudiza E, Pedrón-Giner C. Nutritional Outcome in Home Gastrostomy-Fed Children with Chronic Diseases. Nutrients 2019; 11:nu11050956. [PMID: 31035481 PMCID: PMC6567051 DOI: 10.3390/nu11050956] [Citation(s) in RCA: 6] [Impact Index Per Article: 1.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/25/2019] [Revised: 04/18/2019] [Accepted: 04/23/2019] [Indexed: 12/30/2022] Open
Abstract
The aim of the study was to assess the anthropometric outcomes after gastrostomy tube (GT) placement in children with chronic diseases and the influence of primary diagnosis, age, and nutritional support. A longitudinal, multicenter, and prospective study was performed evaluating 65 children with GT feeding and chronic diseases (61.5% with neurological disease). Each child was evaluated three times (at baseline and at 6 and 12 months after GT placement) and the following data was collected: primary diagnosis, age at GT placement, anthropometry, and feeding regime. Repeated measures ANOVA were used to analyze the main effects (intra and intergroup) and the interactions effects on weight gain and linear growth at 6 and 12 months after GT placement. All patients significantly improved their body mass index (BMI)-for-age z-score (p < 0.001) and height-for-age z-score (p < 0.05) after 6 and 12-month of follow-up. BMI gain increased significantly the first 6 months, followed by a plateau, while height followed a linear trend. Children with GT placement before 18 months old experienced an accelerated growth rate during the first 6 months post-GT. This technique showed the effectiveness of GT placement improving nutritional status and growth catch up regardless of their primary diagnosis and the type of nutritional support.
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Affiliation(s)
- Cecilia Martínez-Costa
- Department of Pediatrics, School of Medicine, University of Valencia, Hospital Clínico Universitario of Valencia, Avenida Blasco Ibáñez 15⁻17, 46010 Valencia, Spain.
- Gastroenterology and Nutrition Unit, Hospital Clínico Universitario, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain.
| | - Caterina Calderón
- Department of Clinical Psychology and Psychobiology, Faculty of Psychology, University of Barcelona, 08035 Barcelona, Spain.
| | - Lilianne Gómez-López
- Department of Pediatrics, School of Medicine, University of Valencia, Hospital Clínico Universitario of Valencia, Avenida Blasco Ibáñez 15⁻17, 46010 Valencia, Spain.
| | - Soraya Borraz
- Department of Pediatrics, Hospital de Dénia, Partida de Beniadtlá s/n. Denia, 03700 Valencia, Spain.
| | - Elena Crehuá-Gaudiza
- Gastroenterology and Nutrition Unit, Hospital Clínico Universitario, Avenida Blasco Ibáñez 17, 46010 Valencia, Spain.
| | - Consuelo Pedrón-Giner
- Gastroenterology and Nutrition Unit, Hospital Infantil Universitario Niño Jesús, Menéndez Pelayo 65, 28009 Madrid, Spain.
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Krom H, van Zundert SM, Otten MAG, van der Sluijs Veer L, Benninga MA, Kindermann A. Prevalence and side effects of pediatric home tube feeding. Clin Nutr 2019; 38:234-239. [DOI: 10.1016/j.clnu.2018.01.027] [Citation(s) in RCA: 21] [Impact Index Per Article: 4.2] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/15/2017] [Revised: 01/16/2018] [Accepted: 01/17/2018] [Indexed: 11/27/2022]
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Lee KJ, Corden TE. Feeding Tubes in Children With Neurologic Impairment: An Opportunity for Shared Decision-making. Pediatrics 2019; 143:peds.2018-3623. [PMID: 30679377 DOI: 10.1542/peds.2018-3623] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 11/27/2018] [Indexed: 11/24/2022] Open
Affiliation(s)
- K Jane Lee
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
| | - Timothy E Corden
- Department of Pediatrics, Medical College of Wisconsin, Milwaukee, Wisconsin
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Dipasquale V, Catena MA, Cardile S, Romano C. Standard Polymeric Formula Tube Feeding in Neurologically Impaired Children: A Five-Year Retrospective Study. Nutrients 2018; 10:E684. [PMID: 29843419 PMCID: PMC6024859 DOI: 10.3390/nu10060684] [Citation(s) in RCA: 18] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/15/2018] [Revised: 05/22/2018] [Accepted: 05/24/2018] [Indexed: 12/11/2022] Open
Abstract
Malnutrition is frequent in neurologically impaired (NI) children. Enteral feeding via gastrostomy tube is increasingly being used to provide adequate nutrition. Our aim was to assess the outcomes of exclusive gastrostomy tube feeding with standard polymeric formula in children with NI, severe oro-motor dysfunction, and malnutrition, and to investigate the role of the underlying NI-associated disease. A five-year retrospective study from January 2013 to November 2017 was conducted. The primary aim was to assess the nutritional outcomes of exclusive gastrostomy tube feeding with standard polymeric formula in malnourished NI children. The secondary aim was to investigate gastrostomy complications and the impact of the underlying NI-associated disease on the nutritional outcomes. We enrolled 110 consecutive children with NI. Of these patients, 34.5% (N = 38) were categorized as malnourished and started exclusive enteral feeding with a standard (1.0 kcal/mL) polymeric formula (Nutrini, Nutricia) after percutaneous endoscopic gastrostomy (PEG) placement. Seventy-three percent of patients (N = 28) had cerebral palsy (CP); other diagnoses included metabolic (13%, N = 5) and genetic (13%, N = 5) diseases. Tricep skinfold thickness had significantly improved in all patients at 12-months follow-up, while body weight and body mass index showed significant increases mainly in children with CP. No serious complications occurred. We found that standard polymeric formula via gastrostomy tube represents a safe and efficient nutritional intervention in children with NI and malnutrition.
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Affiliation(s)
- Valeria Dipasquale
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, 98123 Messina, Italy.
| | - Maria Ausilia Catena
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, 98123 Messina, Italy.
| | - Sabrina Cardile
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, 98123 Messina, Italy.
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, 98123 Messina, Italy.
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Wilken M, Bartmann P, Dovey TM, Bagci S. Characteristics of feeding tube dependency with respect to food aversive behaviour and growth. Appetite 2018; 123:1-6. [DOI: 10.1016/j.appet.2017.11.107] [Citation(s) in RCA: 21] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/22/2017] [Revised: 11/17/2017] [Accepted: 11/27/2017] [Indexed: 12/27/2022]
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Wright CM, Reynolds L, Ingram E, Cole TJ, Brooks J. Validation of US cerebral palsy growth charts using a UK cohort. Dev Med Child Neurol 2017; 59:933-938. [PMID: 28656704 DOI: 10.1111/dmcn.13495] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/19/2017] [Indexed: 11/27/2022]
Abstract
AIM Growth charts for cerebral palsy (CP) have been constructed using data for 24 920 Californian patients, covering ages 2 to 20 years, with separate charts for the five severity levels of the Gross Motor Function Classification System (GMFCS). Our aim was to test how the data for British children with CP fit these charts, compared with conventional local charts. METHOD US CP growth reference was reanalysed using the lambda-mu-sigma (LMS) method to allow calculation of standard deviation z-scores. Growth data for 195 children with CP in Glasgow, UK, were retrieved and converted to z-scores using the CP reference as well as the combined World Health Organization and UK 1990 growth reference (UK-WHO). RESULTS Compared to the UK-WHO reference, measurements diverged progressively with increasing severity, with mean height for GMFCS level V being close to the second UK-WHO centile. Compared with the CP reference, mean height and weight z-scores were between the 50th and 75th centiles for all severity levels, while body mass index was just below the 50th centile. INTERPRETATION British children with severe CP seem relatively very small when their growth data are plotted on non-CP charts, but their data for weight and body mass index fit well to US CP charts and reasonably well for height. The LMS look-up tables will make it possible to calculate z-scores and produce charts in local formats.
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Affiliation(s)
- Charlotte M Wright
- Department of Child Health, MVLS College, University of Glasgow, Glasgow, UK
| | - Lucy Reynolds
- Specialist Children's Services, NHS Greater Glasgow and Clyde, Glasgow, UK
| | - Emily Ingram
- Department of Child Health, MVLS College, University of Glasgow, Glasgow, UK
| | - Tim J Cole
- Department of Life Course Epidemiology and Biostatistics, Great Ormond Street Institute of Child Health, University College, London, UK
| | - Jordan Brooks
- Life Expectancy Project, San Francisco, California, USA
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European Society for Paediatric Gastroenterology, Hepatology and Nutrition Guidelines for the Evaluation and Treatment of Gastrointestinal and Nutritional Complications in Children With Neurological Impairment. J Pediatr Gastroenterol Nutr 2017; 65:242-264. [PMID: 28737572 DOI: 10.1097/mpg.0000000000001646] [Citation(s) in RCA: 185] [Impact Index Per Article: 26.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
OBJECTIVES Feeding difficulties are frequent in children with neurological impairments and can be associated with undernutrition, growth failure, micronutrients deficiencies, osteopenia, and nutritional comorbidities. Gastrointestinal problems including gastroesophageal reflux disease, constipation, and dysphagia are also frequent in this population and affect quality of life and nutritional status. There is currently a lack of a systematic approach to the care of these patients. With this report, European Society of Gastroenterology, Hepatology and Nutrition aims to develop uniform guidelines for the management of the gastroenterological and nutritional problems in children with neurological impairment. METHODS Thirty-one clinical questions addressing the diagnosis, treatment, and prognosis of common gastrointestinal and nutritional problems in neurological impaired children were formulated. Questions aimed to assess the nutritional management including nutritional status, identifying undernutrition, monitoring nutritional status, and defining nutritional requirements; to classify gastrointestinal issues including oropharyngeal dysfunctions, motor and sensory function, gastroesophageal reflux disease, and constipation; to evaluate the indications for nutritional rehabilitation including enteral feeding and percutaneous gastrostomy/jejunostomy; to define indications for surgical interventions (eg, Nissen Fundoplication, esophagogastric disconnection); and finally to consider ethical issues related to digestive and nutritional problems in the severely neurologically impaired children. A systematic literature search was performed from 1980 to October 2015 using MEDLINE. The approach of the Grading of Recommendations Assessment, Development, and Evaluation was applied to evaluate the outcomes. During 2 consensus meetings, all recommendations were discussed and finalized. The group members voted on each recommendation using the nominal voting technique. Expert opinion was applied to support the recommendations where no randomized controlled trials were available.
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20
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Does Gastrostomy Placement With Concurrent Fundoplication Increase the Risk of Gastrostomy-related Complications? J Pediatr Gastroenterol Nutr 2016; 63:29-33. [PMID: 26650105 DOI: 10.1097/mpg.0000000000001063] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVE To compare the incidence of complications with a primary gastrostomy versus gastrostomy with concurrent fundoplication and evaluating the impact of the method of gastrostomy tube placement. Neurologically impaired children were compared with neurologically normal children. Two low profile devices were compared for longevity. METHODS Ninety-eight patients (58 boys, mean age 4.66 years) with 107 gastrostomies inserted between April 2004 and May 2008 were included in this retrospective, single institution audit. Minimum follow-up period was 1 year. Specific complications reviewed were tube and site related. Logistic regression analysis examined the relationship between complications, type of procedure, method of placement, and neurological status. Survival analysis with log-rank test was used to compare the duration of the low-profile devices. RESULTS There were 63 primary gastrostomies and 44 with concurrent fundoplication, 71 children were neurologically impaired. Mean (±SD) follow-up time was 35.6 ± 1.4 months. There was a significant association between concurrent gastrostomy insertion with fundoplication and incidence of infection (odds ratio = 2.4, 95% confidence interval (CI) 1.02-5.56, P = 0.02) and excoriation (odds ratio = 2.5, 95% CI 1.09-5.71, P = 0.015). There were no associations between the complications with gastrostomy placement and neurological status. Failure rate of the balloon device was significantly greater than the fixed bolster device with a Hazard Ratio for survival of 3.2 (95% CI 2.2-4.6). CONCLUSIONS Gastrostomy site-related problems were more common than generally reported. There was a higher incidence of site infection and skin excoriation for gastrostomy placement with concurrent fundoplication. There was no significant difference in complications between the method of gastrostomy placement or neurological status. Balloon devices were changed 3 times more often than bolster retention devices.
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21
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Kapadia MZ, Joachim KC, Balasingham C, Cohen E, Mahant S, Nelson K, Maguire JL, Guttmann A, Offringa M. A Core Outcome Set for Children With Feeding Tubes and Neurologic Impairment: A Systematic Review. Pediatrics 2016; 138:peds.2015-3967. [PMID: 27365302 DOI: 10.1542/peds.2015-3967] [Citation(s) in RCA: 27] [Impact Index Per Article: 3.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 04/27/2016] [Indexed: 11/24/2022] Open
Abstract
CONTEXT Uncertainty exists about the impacts of feeding tubes on neurologically impaired children. Core outcome sets (COS) standardize outcome selection, definition, measurement, and reporting. OBJECTIVE To synthesize an evidence base of qualitative data on all outcomes selected and/or reported for neurologically impaired children 0 to 18 years living with gastrostomy/gastrojejunostomy tubes. DATA SOURCES Medline, Embase, and Cochrane Register databases searched from inception to March 2014. STUDY SELECTION Articles examining health outcomes of neurologically impaired children living with feeding tubes. DATA EXTRACTION Outcomes were extracted and assigned to modified Outcome Measures in Rheumatology 2.0 Filter core areas; death, life impact, resource use, pathophysiological manifestations, growth and development. RESULTS We identified 120 unique outcomes with substantial heterogeneity in definition, measurement, and frequency of selection and/or reporting: "pathophysiological manifestation" outcomes (n = 83) in 79% of articles; "growth and development" outcomes (n = 13) in 55% of articles; "death" outcomes (n = 3) and "life impact" outcomes (n = 17) in 39% and 37% of articles, respectively; "resource use" outcomes (n = 4) in 14%. Weight (50%), gastroesophageal reflux (35%), and site infection (25%) were the most frequently reported outcomes. LIMITATIONS We were unable to investigate effect size of outcomes because quantitative data were not collected. CONCLUSIONS The paucity of outcomes assessed for life impact, resource use and death hinders meaningful evidence synthesis. A COS could help overcome the current wide heterogeneity in selection and definition. These results will form the basis of a consensus process to produce a final COS.
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Affiliation(s)
- Mufiza Z Kapadia
- Toronto Outcomes Research in Child Health (TORCH), Child Health Evaluative Sciences,
| | - Kariym C Joachim
- Toronto Outcomes Research in Child Health (TORCH), Child Health Evaluative Sciences
| | - Chrinna Balasingham
- Toronto Outcomes Research in Child Health (TORCH), Child Health Evaluative Sciences
| | - Eyal Cohen
- Division of Paediatric Medicine, Paediatrics Outcomes Research Team, and Institute of Health Policy, Management and Evaluation, and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada; CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada; and
| | - Sanjay Mahant
- Division of Paediatric Medicine, Paediatrics Outcomes Research Team, and Institute of Health Policy, Management and Evaluation, and CanChild Centre for Childhood Disability Research, McMaster University, Hamilton, Ontario, Canada; and
| | - Katherine Nelson
- Division of Paediatric Medicine, Institute of Health Policy, Management and Evaluation, and Paediatric Advanced Care Team, Department of Paediatrics, The Hospital for Sick Children (SickKids), Toronto, Ontario, Canada
| | - Jonathon L Maguire
- Division of Paediatric Medicine, Department of Paediatrics, Faculty of Medicine, University of Toronto, Toronto, Ontario, Canada; Li Ka Shing Knowledge Institute, and Department of Paediatrics, St. Michael's Hospital, Toronto, Ontario, Canada
| | - Astrid Guttmann
- Division of Paediatric Medicine, Paediatrics Outcomes Research Team, and Institute of Health Policy, Management and Evaluation, and Institute for Clinical Evaluative Sciences, Toronto, Ontario, Canada
| | - Martin Offringa
- Toronto Outcomes Research in Child Health (TORCH), Child Health Evaluative Sciences
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Abstract
Introduction. Over the past 2 decades a dramatic increase of pediatric feeding via tube has been reported, which has resulted in a higher prevalence of feeding tube dependency (FTD). Several treatment programs for FTD have been established over the past 2 decades, but only a few with detailed outlines and definitions of terms have been published. This article will outline the home-based tube weaning program as well review existing evidence. Program Outline. The home-based treatment program is a new treatment modality that allows children to stay in a home environment during treatment. The underlying condition as well as the treatment in its 5 phases have been outlined: assessment, preparation, hunger induction, intensive treatment, and follow-up. Treatment Outcome. Three articles regarding the treatment outcomes of home-based FTD treatment were reviewed. The results of this review show that the success rate of the treatment program has been consistently 90% of the involved cases, with major improvements in eating behavior and without deceleration of growth. Conclusion. The home-based treatment program is a safe and promising new modality for FTD.
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Affiliation(s)
- Markus Wilken
- Institute for Pediatric Feeding Tube Management and Weaning, Siegburg, Germany (MW, VC)
- Sprachpuzzle, Huenfeld, Germany (SE)
| | - Vanessa Cremer
- Institute for Pediatric Feeding Tube Management and Weaning, Siegburg, Germany (MW, VC)
- Sprachpuzzle, Huenfeld, Germany (SE)
| | - Stephan Echtermeyer
- Institute for Pediatric Feeding Tube Management and Weaning, Siegburg, Germany (MW, VC)
- Sprachpuzzle, Huenfeld, Germany (SE)
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Abstract
The decision to initiate enteral feedings is multifaceted, involving medical, financial, cultural, and emotional considerations. Children who have developmental or acquired disabilities are at risk for having primary and secondary conditions that affect growth and nutritional well-being. This clinical report provides (1) an overview of clinical issues in children who have developmental or acquired disabilities that may prompt a need to consider nonoral feedings, (2) a systematic way to support the child and family in clinical decisions related to initiating nonoral feeding, (3) information on surgical options that the family may need to consider in that decision-making process, and (4) pediatric guidance for ongoing care after initiation of nonoral feeding intervention, including care of the gastrostomy tube and skin site. Ongoing medical and psychosocial support is needed after initiation of nonoral feedings and is best provided through the collaborative efforts of the family and a team of professionals that may include the pediatrician, dietitian, social worker, and/or therapists.
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25
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Abstract
Shared decision-making is a process that helps frame conversations about value-sensitive decisions, such as introduction of assistive technology for children with neurologic impairment. In the shared decision-making model, the health care provider elicits family values relevant to the decision, provides applicable evidence in the context of those values, and collaborates with the family to identify the preferred option. This article outlines clinical, quality of life, and ethical considerations for shared decision-making discussions with families of children with neurologic impairment about gastrostomy tube and tracheostomy tube placement.
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Martínez-Biarge M, Blanco D, García-Alix A, Salas S. [Follow-up of newborns with hypoxic-ischaemic encephalopathy]. An Pediatr (Barc) 2013; 81:52.e1-14. [PMID: 24290154 DOI: 10.1016/j.anpedi.2013.06.015] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/26/2013] [Accepted: 06/27/2013] [Indexed: 11/19/2022] Open
Abstract
Hypothermia treatment for newborn infants with hypoxic-ischemic encephalopathy reduces the number of neonates who die or have permanent neurological deficits. Although this therapy is now standard of care, neonatal hypoxic-ischaemic encephalopathy still has a significant impact on the child's neurodevelopment and quality of life. Infants with hypoxic-ischaemic encephalopathy should be enrolled in multidisciplinary follow-up programs in order to detect impairments, to initiate early intervention, and to provide counselling and support for families. This article describes the main neurodevelopmental outcomes after term neonatal hypoxic-ischaemic encephalopathy. We offer recommendations for follow-up based on the infant's clinical condition and other prognostic indicators, mainly neonatal neuroimaging. Other aspects, such as palliative care and medico-legal issues, are also briefly discussed.
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Affiliation(s)
- M Martínez-Biarge
- Department of Paediatrics, Hammersmith Hospital, Imperial College, Londres, Reino Unido.
| | - D Blanco
- Servicio de Neonatología, Hospital Universitario Gregorio Marañón, Madrid, España
| | - A García-Alix
- Servicio de Neonatología, Hospital Sant Joan de Déu, Barcelona, España
| | - S Salas
- Servicio de Neonatología, Hospital Universitario La Paz, Madrid, España
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Wilken M, Cremer V, Berry J, Bartmann P. Rapid home-based weaning of small children with feeding tube dependency: positive effects on feeding behaviour without deceleration of growth. Arch Dis Child 2013; 98:856-61. [PMID: 23864356 DOI: 10.1136/archdischild-2012-303558] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/14/2022]
Abstract
BACKGROUND Oral aversion and feeding disorders occur frequently after long-term feeding via a tube. A rapid home-based tube-weaning programme that provides feeding disorder treatment under medical supervision to overcome oral aversion has been developed. AIMS To describe the results of the 4-10-day rapid home-based feeding tube-weaning programme and to determine the prevalence of food aversion and the overall longitudinal effects on feeding behaviour and growth after treatment. SUBJECTS AND METHODS The parents of children who participated in the programme between 2005 and 2007 were followed up via questionnaire in 2008. The questionnaire included inquiries about the characteristics of tube feeding, feeding behaviour and growth parameters. RESULTS The study group comprised of 18 boys and 21 girls who, at entry, had a median age of 16 months (range, 5-57) and a median duration of tube feeding of 15 months (range, 3-56). The children were followed up for a median of 2 years after treatment (range, 1-3 years). The weaning programme established oral feeding in 89.7% of the children. In all cases where oral feeding was achieved, the feeding behaviour improved after treatment. The growth velocity of all children, as indicated by weight, length and body mass index (BMI), remained constant from the initial evaluation (BMI z-score M=-1.1 ± 1.7) to follow-up (BMI z-score M=-1.2 ± 1.1). CONCLUSIONS This rapid weaning programme for children with feeding tube dependency (FTD) improved the feeding behaviour and was associated with constant growth velocity.
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Affiliation(s)
- Markus Wilken
- Institute for Pediatric Feeding Tube Management and Weaning, Siegburg, Germany
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Long-term outcome after percutaneous endoscopic gastrostomy in children. Pediatr Neonatol 2013; 54:326-9. [PMID: 23721827 DOI: 10.1016/j.pedneo.2013.04.008] [Citation(s) in RCA: 24] [Impact Index Per Article: 2.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/13/2012] [Revised: 11/26/2012] [Accepted: 04/26/2013] [Indexed: 01/14/2023] Open
Abstract
BACKGROUND Percutaneous endoscopic gastrostomy (PEG) is widely accepted as the preferred procedure to establish long-term enteral feeding. OBJECTIVE To learn the long-term outcomes of the patients who have undergone PEG placement, we reviewed our experience with children who underwent this procedure in our institute. METHODS A total of 83 pediatric patients (42 males and 41 females), who were aged from 3 months to 20 years, underwent PEG insertion in National Taiwan University Hospital from January 2000 to April 2011. The underlying diseases of the patients receiving PEG were neurological dysfunction (n = 67), metabolic disorders (n = 9), gastrointestinal disease (n = 2), and congenital heart disease (n = 1). This procedure was performed under intravenous sedation or under general anesthesia. Prophylactic antibiotics were administered for 1 day. Tube feeding began 24 hours after the PEG placement. The body weight of the patients was recorded 1 day before PEG placement and at least 6 months after PEG placement. RESULTS The weight-for-age Z-score before and at 6 months after PEG placement were -1.5 ± 2.0 and -0.9 ± 2.1, respectively, which was statistically significant (paired t test, p = 0.006). The catch-up growth was recorded after PEG placement. Complications of PEG in our patients included cellulitis at the gastrostomy wound (n = 14), dislodgement of the tube (n = 17), and persistent gastrocutaneous fistula (n = 3). The PEG tube was removed permanently in seventeen patients because they resumed an adequate oral intake. During the follow-up period, 14 patients died of an underlying disease or infection. CONCLUSION Our experience confirmed that PEG placement is a good long-term route for nutritional supply with no serious complications in children.
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Leonard H, Ravikumara M, Baikie G, Naseem N, Ellaway C, Percy A, Abraham S, Geerts S, Lane J, Jones M, Bathgate K, Downs J. Assessment and management of nutrition and growth in Rett syndrome. J Pediatr Gastroenterol Nutr 2013; 57:451-60. [PMID: 24084372 PMCID: PMC3906202 DOI: 10.1097/mpg.0b013e31829e0b65] [Citation(s) in RCA: 42] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES We developed recommendations for the clinical management of poor growth and weight gain in Rett syndrome through evidence review and the consensus of an expert panel of clinicians. METHODS Initial draft recommendations were created based upon literature review and 34 open-ended questions in which the literature was lacking. Statements and questions were made available to an international, multidisciplinary panel of clinicians in an online format and a Microsoft Word-formatted version of the draft via e-mail. Input was sought using a 2-stage modified Delphi process to reach consensus. Items included clinical assessment of growth, anthropometry, feeding difficulties and management to increase energy intake, decrease feeding difficulties, and consideration of gastrostomy. RESULTS Agreement was achieved on 101 of 112 statements. A comprehensive approach to the management of poor growth in Rett syndrome is recommended that takes into account factors such as feeding difficulties and nutritional needs. A body mass index of approximately the 25th centile can be considered as a reasonable target in clinical practice. Gastrostomy is indicated for extremely poor growth, if there is risk of aspiration and if feeding times are prolonged. CONCLUSIONS These evidence- and consensus-based recommendations have the potential to improve care of nutrition and growth in a rare condition and stimulate research to improve the present limited evidence base.
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Affiliation(s)
- Helen Leonard
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Western Australia
| | - Madhur Ravikumara
- Department of Gastroenterology, Princess Margaret Hospital for Children, Perth, Western Australia
| | - Gordon Baikie
- Department of Developmental Medicine, Royal Children’s Hospital, Murdoch Children’s Research Institute, Melbourne, Australia
| | - Nusrat Naseem
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Western Australia
| | - Carolyn Ellaway
- Western Sydney Genetics Program, The Children’s Hospital at Westmead, Discipline of Paediatrics and Genetic Medicine, University of Sydney, Australia
| | - Alan Percy
- Civitan International Research Centre, University of Alabama, Birmingham, Alabama, USA
| | - Suzanne Abraham
- Department of Otolaryngology Head Neck Surgery and Radiology, Albert Einstein College of Medicine, Montefiore Medical Center, Bronx, New York, USA
| | - Suzanne Geerts
- Civitan International Research Centre, University of Alabama, Birmingham, Alabama, USA
| | - Jane Lane
- Civitan International Research Centre, University of Alabama, Birmingham, Alabama, USA
| | - Mary Jones
- Katie's Clinic for Rett Syndrome, Children's Hospital & Research Center, Oakland, California, USA
| | - Katherine Bathgate
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Western Australia
- School of Public Health and Curtin Health Innovation Research Institute, Perth, Western Australia
| | - Jenny Downs
- Telethon Institute for Child Health Research, Centre for Child Health Research, University of Western Australia, Perth, Western Australia
- School of Physiotherapy and Curtin Health Innovation Research Institute, Perth, Western Australia
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Åvitsland TL, Birketvedt K, Bjørnland K, Emblem R. Parent-Reported Effects of Gastrostomy Tube Placement. Nutr Clin Pract 2013; 28:493-8. [DOI: 10.1177/0884533613486484] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Affiliation(s)
- Tone Lise Åvitsland
- Department of Pediatric Surgery, Oslo University Hospital, Oslo, Norway
- Department of Pediatric Surgery, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
| | - Kjersti Birketvedt
- National Resource Center for Feeding and Nutritional Difficulties in Children, Section for Child Neurology, Oslo University Hospital, Oslo, Norway
| | - Kristin Bjørnland
- Department of Pediatric Surgery, Oslo University Hospital, Oslo, Norway
| | - Ragnhild Emblem
- Department of Pediatric Surgery, Oslo University Hospital, Oslo, Norway
- Department of Pediatric Surgery, Institute of Clinical Medicine, University of Oslo, Oslo, Norway
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Martínez-Costa C, Calderón C, Pedrón-Giner C, Borraz S, Gómez-López L. Psychometric properties of the structured Satisfaction Questionnaire with Gastrostomy Feeding (SAGA-8) for caregivers of children with gastrostomy tube nutritional support. J Hum Nutr Diet 2012. [PMID: 23190211 DOI: 10.1111/jhn.12000] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/27/2022]
Abstract
BACKGROUND To analyse the psychometric properties of the structured Satisfaction Questionnaire with Gastrostomy Feeding (SAGA-8) in parents/caregivers of children with home enteral nutrition (HEN) by gastrostomy tube (GT). METHODS Eighty-six caregivers (mothers) of paediatric patients with HEN by GT were recruited. Patients suffered from neurological disease (61.6%) and other chronic diseases. The SAGA-8 scale, a structured questionnaire to explore satisfaction with HEN by GT, and the Caregiver Burden Inventory (Zarit) were completed. The discriminating power of each of the SAGA-8 items, internal consistency and external validity were evaluated. An exploratory factor analysis and Kaiser-Meyer-Olkin (KMO) was performed as well. RESULTS Eighty-four percent of the families expressed high satisfaction with GT feeding. All eight items of SAGA-8 gave additional information. The exploratory factor analysis revealed that a significant part of the items' variability could be explained by two independent factors: Factor 1 (direct benefit), which compiled the variables related to the perception of children's overall improvement by GT feeding; Factor 2 (indirect benefit), which grouped the variables related to a decrease in respiratory infections, feeding time and institutional support. Results from KMO (0.628) indicated the high adequacy of the items assessed in the factorial analysis. Moreover, the questionnaire presented high internal consistency (0.76), and the external validation analysis confirmed the correlation between SAGA-8 and Zarit, thereby emphasising the approptiate use of the SAGA-8 to detect carers' satisfaction. CONCLUSIONS The SAGA-8 questionnaire has a high discriminatory power to assess the degree of satisfaction experienced by parents/caregivers of children with HEN by GT and, subsequently, the patients' wellbeing.
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Affiliation(s)
- C Martínez-Costa
- Department of Pediatrics, School of Medicine, University of Valencia, Valencia, Spain.
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Maternal psychological distress and parenting stress after gastrostomy placement in children. J Pediatr Gastroenterol Nutr 2012; 55:562-6. [PMID: 22644463 DOI: 10.1097/mpg.0b013e31826078bd] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES The aim of the study was to evaluate stress in mothers of children with feeding problems before and after gastrostomy placement, and to identify changes in child health and variables affecting maternal stress. METHODS Psychological distress and parenting stress in 34 mothers of children referred for gastrostomy were assessed using general health questionnaire (GHQ) (overall psychological distress), impact of event scale (IES) (intrusive stress related to child's feeding problems), and parenting stress index (PSI) (stress related to parenting) before, 6, and 18 months after placement of a gastrostomy. Information of child health and long-term gastrostomy complications were recorded. A semistructured interview constructed for the present study explored maternal preoperative expectations and child's quality of life. RESULTS Insertion of a gastrostomy did not significantly influence vomiting or the number of children with a low weight-for-height percentile. All of the children experienced peristomal complications. Despite this, mothers' overall psychological distress was significantly reduced after 6 and 18 months, and the majority of mothers (85%) reported that their preoperative expectations were fulfilled and that the child's quality of life was improved after gastrostomy placement. Maternal concerns for the child's feeding problems, measured as intrusive stress, had effect on maternal overall psychological distress. CONCLUSIONS Despite frequent stomal complications the gastrostomy significantly reduced the mothers' psychological distress and improved the child's quality of life as reported by the mother.
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Feeding and communication impairments in infants with central grey matter lesions following perinatal hypoxic-ischaemic injury. Eur J Paediatr Neurol 2012; 16:688-96. [PMID: 22658307 DOI: 10.1016/j.ejpn.2012.05.001] [Citation(s) in RCA: 46] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/10/2011] [Revised: 04/25/2012] [Accepted: 05/01/2012] [Indexed: 01/04/2023]
Abstract
BACKGROUND Basal ganglia and thalamic (BGT) injury is common after acute perinatal hypoxia-ischaemia. Cerebral palsy is the most obvious consequence of BGT injury affecting 70-75% of survivors and is predictable from neonatal magnetic resonance imaging (MRI). However there is no equivalent predictive data for other specific outcomes. Feeding and communication impairments are also common in children following hypoxic-ischaemic encephalopathy (HIE) and BGT injury. AIMS To describe, in infants with HIE and BGT injury, the prevalence of feeding and communication impairments; and to evaluate the accuracy of early MRI for predicting these outcomes. METHODS 175 term infants with HIE and BGT injury were studied. Brain lesions were classified by site and severity from the MRI scans. Motor, feeding and communication impairments were documented at 2 years. RESULTS Feeding and communication impairments occurred in 65% and 82% of 126 survivors respectively and related strongly to the severity of motor impairment. Forty-one children had a gastrostomy or long-term nasogastric tube. Injury severity in all brain regions was significantly associated with feeding and communication impairment on univariate analysis. On logistic regression analysis BGT (OR 10.9) and mesencephalic lesions (OR 3.7) were independently associated with feeding impairment; BGT (OR 10.5) and pontine lesions (OR 3.8) were associated with gastrostomy; the severity of BGT lesions (OR 20.1) was related to the severity of communication impairment. CONCLUSIONS Feeding and communication impairment are very common in children with BGT and brainstem injury of neonatal origin and can be well predicted from early MRI scans.
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Craig GM, Higgs P. Risk owners and risk managers: Dealing with the complexity of feeding children with neurodevelopmental disability. HEALTH RISK & SOCIETY 2012. [DOI: 10.1080/13698575.2012.717610] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
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Dahlseng MO, Finbråten AK, Júlíusson PB, Skranes J, Andersen G, Vik T. Feeding problems, growth and nutritional status in children with cerebral palsy. Acta Paediatr 2012; 101:92-8. [PMID: 21767308 DOI: 10.1111/j.1651-2227.2011.02412.x] [Citation(s) in RCA: 75] [Impact Index Per Article: 6.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
AIM The aim was to estimate the prevalence of feeding and nutritional problems in children with cerebral palsy (CP) in Norway. METHODS Data were abstracted from the Norwegian CP Register for 661 (368 boys) children born 1996-2003 (mean age 6 years 7 months; SD: 1.5). For children born from 1999 to 2003, weight and height were available. Body mass index (BMI) (kg/m(2)) was used to assess nutritional status. RESULTS One hundred and thirty-two (21%) children with CP were completely dependent on assistance during feeding. The prevalence of gastrostomy tube feeding was 14%. Longer duration of gastrostomy tube feeding was associated with higher weight and BMI, but not with height. Only 63% of the children with CP had normal BMI, 7% had grade 3 thinness, while the prevalence of overweight and obesity in our study was 16%. In all, 20% of the children had mean z-scores for weight and/or height below - 2 SD. CONCLUSION Feeding problems in children with CP were common and associated with poor linear growth. A high proportion of the children were undernourished. Moreover, our results suggest that gastrostomy tube feeding may have been introduced too late in some children.
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Affiliation(s)
- Magnus Odin Dahlseng
- Department of Laboratory Medicine, Children's and Women's Health, Faculty of Medicine, Norwegian University of Science and Technology, Trondheim, Norway.
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Lefton-Greif MA, Crawford TO, McGrath-Morrow S, Carson KA, Lederman HM. Safety and caregiver satisfaction with gastrostomy in patients with Ataxia Telangiectasia. Orphanet J Rare Dis 2011; 6:23. [PMID: 21569628 PMCID: PMC3116459 DOI: 10.1186/1750-1172-6-23] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/04/2010] [Accepted: 05/15/2011] [Indexed: 11/30/2022] Open
Abstract
Background Ataxia Telangiectasia (A-T) is a rare monogenetic neurodegenerative disease with pulmonary, nutritional, and dysphagic complications. Gastrostomy tube (GT) feedings are commonly recommended to manage these co-morbidities. In general, outcomes of GT placement in patients with progressive diseases that develop during childhood are not well characterized. The primary purposes of this study were to determine whether GT placement in patients with A-T would be tolerated and associated with caregiver satisfaction. Methods We completed a retrospective review of 175 patients who visited the A-T Children's Center at Johns Hopkins Hospital from 2001 through 2008, and identified 28 patients with A-T (19 males, 9 females) who underwent GT placement for non-palliative reasons. Information was obtained from medical records, interviews with primary health care providers, and 24 (83%) caregivers of patients with GT's who responded to survey requests. Results Twenty-five (89%) patients tolerated GT placement and were a median of 5.0 (0.4-12.6) years post GT placement at the time of this investigation. Three (11%) patients died within one month of GT placement. In comparison to patients who tolerated GT placement, patients with early mortality were older when GT's were placed (median 24.9 vs. 12.3 years, p = 0.006) and had developed a combination of dysphagia, nutritional, and respiratory problems. Caregivers of patients tolerating GT placement reported significant improvements in mealtime satisfaction and participation in daily activities. Conclusions GT placement can be well tolerated and associated with easier mealtimes in patients with A-T when feeding tubes are placed at young ages. Patients with childhood onset of disorders with predictable progression of the disease process and impaired swallowing may benefit from early versus late placement of feeding tubes.
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Affiliation(s)
- Maureen A Lefton-Greif
- The Ataxia Telangiectasia Clinical Center, Johns Hopkins Medical Institutions, Baltimore, Maryland, USA.
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Martínez-Costa C, Borraz S, Benlloch C, López-Sáiz A, Sanchiz V, Brines J. Early decision of gastrostomy tube insertion in children with severe developmental disability: a current dilemma. J Hum Nutr Diet 2011; 24:115-21. [PMID: 21332837 DOI: 10.1111/j.1365-277x.2010.01146.x] [Citation(s) in RCA: 32] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/01/2022]
Abstract
BACKGROUND Healthcare professionals advise earlier gastrostomy tube (GT) placement in children with severe developmental disabilities, marked feeding disorders and risk of malnutrition. However, a delay in acceptance of the procedure by parents/guardians is the main issue of concern. The present study aimed to investigate: (i) parental satisfaction with GT feeding and whether parents/carers would have accepted earlier GT placement and (ii) subsequent nutritional outcome. METHODS Twenty-six disabled children with GT feeding were recruited. A structured questionnaire by telephone was held to record parental perceptions of GT (mainly satisfaction with the procedure and patient management). A longitudinal study (0-6-12 months) was designed to investigate anthropometric outcome. Nutritional support mode and GT-related complications were also recorded. RESULTS Parents/carers showed high satisfaction (91%). Furthermore, 87% recognised that they would have accepted an earlier placement of the GT had they anticipated the outcome. Patient management and family dynamics were acknowledged to have improved considerably. Nutritional assessment demonstrated a positive trend in weight. Height improved significantly 6 months post-implantation (P = 0.045) and body mass index improved after 12 months (P = 0.041). When comparing nutritional outcome between children in whom the GT was placed before 18 months of age and those in whom it was placed later, height was found to improve significantly in the first group (P = 0.04). CONCLUSIONS Most parents/carers would have agreed to earlier GT feeding of their children had they acknowledged its benefits. Although nutritional response was positive, it was less so than the parental perception of children's overall improvement. Growth rates were significantly increased when GT was placed early in life.
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Affiliation(s)
- C Martínez-Costa
- Department of Pediatrics, School of Medicine, University of Valencia, Valencia, Spain.
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Vernon-Roberts A, Wells J, Grant H, Alder N, Vadamalayan B, Eltumi M, Sullivan PB. Gastrostomy feeding in cerebral palsy: enough and no more. Dev Med Child Neurol 2010; 52:1099-105. [PMID: 20964670 DOI: 10.1111/j.1469-8749.2010.03789.x] [Citation(s) in RCA: 34] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/28/2022]
Abstract
AIM gastrostomy feeding children with spastic quadriplegic cerebral palsy (SQCP) improves weight gain but may cause excess deposition of body fat. This study was designed to investigate whether weight gain could be achieved without an adverse effect on body composition by using a low-energy feed in gastrostomy-fed children with SQCP. METHOD ourteen children (seven male; seven female; median age 2y; range 10mo-11y) with SQCP were studied, 13 of whom were classified as Gross Motor Function Classification Score (GMFCS) level V and one as GMFCS level IV. Children were eligible for the study if they weighed between 8 and 30kg with a diagnosis of severe SQCP and significant feeding difficulties in whom a clinical decision had been made to insert a gastrostomy feeding tube. The feed used in the study had an energy concentration of 0.75kcal/mL (Nutrini Low Energy Multi Fibre). Assessments were performed before gastrostomy insertion (baseline) and after 6months, and included body composition, growth, nutritional intake, and gastrointestinal symptoms. RESULTS there was a significant increase in weight (median difference 1.9kg; 95% confidence interval [CI] 0.85-3.03kg; p=0.012), mid-upper arm circumference (median difference 1.45cm; 95% CI -0.36cm to 3.47cm; p=0.043), and lower leg length (median difference 1.62cm; 95% CI 0.44-3.95cm; p=0.012) over the 6 months. There was no significant increase in fat mass index (median diff 1.21, 95% CI -1.15 to 2.94, p=0.345) or fat free mass index (median diff -1.43, 95% CI -1.15 to 2.94, p=0.249). Micronutrient levels remained within reference ranges with the exception of elevated chromium. The median percentage intake of the estimated average requirements for energy (kcal) was 43% at the beginning of the study and 48.8% after 6 months on the low-energy feed. INTERPRETATION children with SQCP who are fed a low-energy, micronutrient-complete, high-fibre feed continue to grow even with energy intakes below 75% of the estimated average requirements. This was not associated with a disproportionate rise in fat mass or fat percentage, and the majority of micronutrient levels remained within the reference range.
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Abstract
Half of the most severe cases of cerebral palsy (CP) survive to adulthood, but because this longevity is relatively recent, there is no empirical experience of their life expectancy past middle age. The last 2 decades have seen significant developments in the management of persons with CP, involving specialist services from an increasing number of disciplines that require coordination to maximize their effectiveness. This article provides an overview of CP. The author discusses definitions of CP, its epidemiology, pathologies, and range of possible clinical descriptions, and briefly touches on management and prevention.
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Affiliation(s)
- Eve Blair
- Division of Population Sciences, Centre for Child Health Research, University of Western Australia at The Telethon Institute for Child Health Research, West Perth, WA 6872, Australia.
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Srinivasan R, Irvine T, Dalzell AM. Traction removal of percutaneous endoscopic gastrostomy devices in children. Dig Dis Sci 2010; 55:2874-7. [PMID: 20033842 DOI: 10.1007/s10620-009-1090-z] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/03/2009] [Accepted: 12/03/2009] [Indexed: 12/24/2022]
Abstract
BACKGROUND There are few published data on non-endoscopic removal of percutaneous endoscopic gastrostomy devices in children. AIMS To describe prospective data acquired for traction removal of percutaneous endoscopic gastrostomy devices at a single pediatric center over a 5-year period. METHODS Data were obtained from endoscopy records, computerized hospital patient information systems and case note analysis. The device that could be removed by traction was the Corflo (Merck) 12-Fr percutaneous endoscopic gastrostomy tube with a collapsible internal retention dome. All procedures were performed under general anesthesia. RESULTS Between 2002-2006, 220 children underwent percutaneous endoscopic gastrostomy removals (166 by traction, 51 endoscopically and 3 Foley catheter to button conversions). The median duration between percutaneous endoscopic gastrostomy insertion and low profile button device substitution was 0.83 years (0.12-3.86). Complications from traction removal included internal retention dome separation in two cases (allowed to pass per rectum, uneventfully), failure to a insert a low profile button device needing percutaneous endoscopic gastrostomy reinsertion, enterocutaneous fistula requiring surgical closure in one patient and laparoscopy for suspected low profile button device misplacement in one instance. The material cost of endoscope disinfection (£10) and disposable usage (£80) avoided by traction removal was calculated at £90 per procedure. CONCLUSION No mortality occurred as a result of the traction removal of percutaneous endoscopic gastrostomy tubes. Laparoscopy for suspected low profile button device misplacement was needed in one case (0.60%). Traction removal of percutaneous endoscopic gastrostomy tubes was generally safe and a cost-saving procedure in our experience.
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Affiliation(s)
- Ramesh Srinivasan
- Department of Pediatric Gastroenterology, Alder Hey Children's NHS Foundation Trust, Eaton Road, Liverpool, L12 2AP, UK.
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Gastrostomy tube feeding: when to start, what to feed and how to stop. Eur J Clin Nutr 2010; 64 Suppl 1:S17-21. [PMID: 20442720 DOI: 10.1038/ejcn.2010.43] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/10/2023]
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Abstract
OBJECTIVE : To describe the indications and practice of percutaneous endoscopic gastrostomy (PEG) device insertion for nutritional support and to ascertain procedure-related complications and outcome. METHODS : Observational study with prospectively collected data on children who underwent PEG-related procedures (PEG insertion, removal, or change to low profile button devices [LPBD]) for a 5-year period (2002-2006) at our centre. RESULTS : Six hundred one PEG-related procedures were performed during the study period (384 insertions, 165 conversions to LPBD, 49 permanent PEG removals, and 3 PEG reinsertions). The main indications for PEG insertion were feeding difficulties associated with neurodisability (160/384; 41.6%) and congenital heart disease (CHD 115/384; 30%). Children with CHD required feeding nutritional support at an earlier age than children with neurodisability regardless of underlying cardiac condition. The age of PEG insertion was significantly different between the 2 main groups (neurodisability 3.56 years vs CHD 0.39 years; P < 0.001 [t test]). Fifty-nine patients were discharged on the same day as PEG insertion without complications (day case gastrostomy). The median time between PEG insertion to LPBD conversion was 0.83 year (0.12-3.86). Twenty-four of the 49 children having permanent PEG removal had CHD. CONCLUSIONS : Neurodisabilty and CHD were the main indications for PEG insertion, those with CHD requiring feeding support at an earlier age. Although CHD was an indication for PEG insertion in 30% of instances, a greater percentage of PEG removals (50%) were seen in this group indicating resolution of feeding difficulties.
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Lee L, MacPherson M. Long-term percutaneous endoscopic gastrostomy feeding in young adults with multiple disabilities. Intern Med J 2009; 40:411-8. [PMID: 19849746 DOI: 10.1111/j.1445-5994.2009.02108.x] [Citation(s) in RCA: 11] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/17/2023]
Abstract
AIM To study the outcomes from initiation of percutaneous endoscopic gastrostomy (PEG) feeding in young people with profound multiple disabilities. METHODS Observations were made on 40 adults with lifelong intellectual disability (mental retardation) and quadriplegia, in whom PEG feeding was initiated during 1990-2008. There were 20 men and 20 women aged 15-40 years at the time of the audit, living in settings with 24 h registered nurse staffing. RESULTS Undernutrition and recurrent aspiration with frequent infections were cited as reasons for PEG feeding. The positive outcomes were that some were said to be more alert for a time following the procedure; and these young adults lived with PEG feeding for an average of 8.5 years, some up to 18 years. In that time, however, they all experienced complications of the PEG insertion, and of the PEG feeding process. There were no measurable improvements in cognition. There were no reductions in prescription of medications. They all required frequent daily interventions by nurses to maintain medical stability. Ten people died during this review period, from continued deterioration in neurological status, with pneumonia cited as the terminal event. CONCLUSIONS Unlike other people with neurological deterioration, young adults with lifelong multiple disabilities may live for many years with PEG feeding. There is little gain in quality of life.
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Affiliation(s)
- L Lee
- Department of Rehabilitation Medicine, Concord Hospital, Sydney, New South Wales 2139, Australia
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Perceptions of caregivers following percutaneous endoscopic gastrostomy in children with congenitally malformed hearts. Cardiol Young 2009; 19:507-10. [PMID: 19703335 DOI: 10.1017/s1047951109990680] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/05/2022]
Abstract
INTRODUCTION While the usefulness of percutaneous endoscopic gastrostomy is clearly established in the nutritional support of children with neurodisability, the role in substituting for prolonged nasogastric feeding in children with congenitally malformed hearts is a relatively recent development. There are no previously published experiences of the perceptions of parents or those providing care following the insertion of percutaneous endoscopic gastrostomy in such children. METHODS Descriptive qualitative survey of parental perceptions using a semi-structured questionnaire. RESULTS We obtained completed 27 point semi-structured questionnaires from 38 providers of care for children with congenitally malformed hearts. Time taken to feed their children reduced significantly after the percutaneous endoscopic gastrostomy, from 30 to 60 minutes previously to 15 minutes subsequently. The frequency of feeding also reduced significantly, from 6 times a day to 4 to 5 times a day. Those providing care perceived significant reductions in pre-procedural symptoms, the ease of administering medications, and noted an enhanced level of happiness in their children. Of those providing care, 97% were highly satisfied with the procedure, with 15 parents (40%) wishing that the operation was done earlier, while the remainder considered it had been done at the appropriate time. CONCLUSIONS Those caring for children with congenitally malformed hearts perceive significant improvements in the symptoms, wellbeing, and ease of administering medication for their children after percutaneous endoscopic gastrostomy. Of the group, 97% regarded the procedure as the appropriate means of assisting nutritional support.
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Gisel E. Interventions and outcomes for children with dysphagia. ACTA ACUST UNITED AC 2008; 14:165-73. [DOI: 10.1002/ddrr.21] [Citation(s) in RCA: 33] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
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Abstract
OBJECTIVES Feeding difficulties in Rett syndrome are complex and multifactorial. In this study, we describe the feeding experiences in Rett syndrome and examine the factors affecting growth. MATERIALS AND METHODS Using questionnaire data related to a population-based cohort, ages 2 to 29 years (n = 201), we measured the feeding experiences, growth, and factors affecting growth (enteral nutritional support, mutations, mobility, breath-holding, hyperventilation) in subjects with Rett syndrome. RESULTS The mean weight, height, and body mass index z scores in subjects with Rett syndrome were below that of their age group and decreased steadily with age. Twenty percent of subjects had enteral nutrition support, and it was more common in the older age group. Those with truncating mutations had significantly less enteral nutrition support than the other mutation groups. Furthermore, those with low mobility had lower mean body mass index z scores than those with higher mobility, and increased frequency of breath-holding and hyperventilation also was associated with lower body mass index z scores. CONCLUSIONS Routine monitoring of growth should continue to determine the severity of nutritional problems in Rett syndrome. Active nutritional management is recommended to ensure females affected with Rett syndrome have the best opportunity to reach their growth potential.
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Partrick DA. Gastrointestinal tract feeding access and the role of fundoplication in combination with gastrostomy. Curr Opin Pediatr 2007; 19:333-7. [PMID: 17505196 DOI: 10.1097/mop.0b013e32815745bd] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/18/2023]
Abstract
PURPOSE OF REVIEW Feeding access and associated antireflux procedures continue to be some of the most common operations performed in pediatric patients. This review will discuss the various feeding access procedures available, including minimally invasive techniques, and further elaborate on appropriate indications for a concurrent antireflux procedure as well as alternatives to fundoplication. RECENT FINDINGS Gastrostomy and jejunostomy can be successfully placed using endoscopic or laparoscopic techniques with low complication rates. Nissen fundoplication is well described laparoscopically but failure with recurrent gastroesophageal reflux has resulted in the development of other operative alternatives. SUMMARY Decisions concerning appropriate long-term feeding access must be individualized, understanding the advantages and disadvantages of gastrostomy and jejunostomy techniques. Laparoscopic Nissen fundoplication is successful for treatment of patients who fail medical therapy of gastroesophageal reflux, but recurrent gastroesophageal reflux is a persistent problem that requires innovative solutions.
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Affiliation(s)
- David A Partrick
- University of Colorado Health Sciences Center, and Department of Pediatric Surgery, The Children's Hospital, 1056 East 19th Avenue, Denver, CO 80218, USA.
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