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Nasher O, Thornber J, Dean J, Goldthorpe J, Rajfeld L, Smith L, Hannon E. The principles of enhanced recovery after percutaneous endoscopic gastrostomy (ERaPEG): a UK tertiary center experience. Pediatr Surg Int 2024; 40:123. [PMID: 38704451 DOI: 10.1007/s00383-024-05693-1] [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: 04/08/2024] [Indexed: 05/06/2024]
Abstract
PURPOSE Enhanced recovery after surgery (ERAS) pathways have been shown to improve surgical outcomes and patient satisfaction. The aim of the study was to assess whether the implementation of a perioperative enhanced recovery after percutaneous endoscopic gastrostomy (ERaPEG) pathway based on ERAS principles was safe, satisfactory to parents and improved outcomes. METHODS Following a quality improvement project, a multimodal ERaPEG pathway was introduced as standard practice within the department and children undergoing elective same-day admission percutaneous endoscopic gastrostomy (PEG) at a single UK tertiary center were prospectively enrolled. Exclusion criteria were patients undergoing other concurrent procedures and those who underwent a laparoscopic assisted/open procedure. Data included patient demographics, underlying diagnosis, indication, length of stay (LOS) and 30-day readmission. Parental experience and satisfaction were determined using a questionnaire including 5-point Likert scales. A retrospective cohort was used for comparison. Data were analyzed using Chi-Square test and Mann-Whitney U tests. RESULTS Ninety-five patients met the inclusion criteria: 50 pre and 45 post the implementation of ERaPEG. Median age was 3 and 2 years, respectively. Neurodisability was the underlying diagnosis in most patients (84%-pre-ERaPEG; 76%-post-ERaPEG). Most common PEG indication was medication/nutritional supplementation (52%-pre-ERaPEG; 51%-post-ERaPEG). The LOS significantly decreased from a median of 51.5 h (pre-ERaPEG) to 32 h (post-ERaPEG) (p < 0.001). Thirty-day readmission rates were similar (6% vs 11%). Most parents felt that the educational material was easy to access and understand. Post-operatively the majority of parents (≥ 80%) were confident in managing the gastrostomy device, setting up/giving the feeds and also felt that the LOS was appropriate. CONCLUSION This study shows that the implementation of an ERaPEG pathway significantly reduced LOS following PEG. In addition, the pathway was satisfactory to parents and offered the benefit of improved resource utilization.
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Affiliation(s)
- Omar Nasher
- Department of Pediatric Surgery, Leeds Children's Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, UK.
| | - Julia Thornber
- Nutrition & Dietetics, Leeds Children's Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Joanne Dean
- Department of Pediatric Gastroenterology, Leeds Children's Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Jenny Goldthorpe
- Department of Pediatric Gastroenterology, Leeds Children's Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Linsay Rajfeld
- Department of Pediatric Gastroenterology, Leeds Children's Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Liz Smith
- Department of Pediatric Surgery, Leeds Children's Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
| | - Edward Hannon
- Department of Pediatric Surgery, Leeds Children's Hospital, The Leeds Teaching Hospitals NHS Trust, Leeds, UK
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Wong K, Davies G, Leonard H, Downs J, Junaid M, Amin S. Growth patterns in individuals with CDKL5 deficiency disorder. Dev Med Child Neurol 2024; 66:469-482. [PMID: 37804112 DOI: 10.1111/dmcn.15777] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2023] [Revised: 09/03/2023] [Accepted: 09/07/2023] [Indexed: 10/08/2023]
Abstract
AIM To compare growth in individuals with cyclin-dependent kinase-like 5 (CDKL5) deficiency disorder with population norms and to investigate the effect of gastrostomy on growth. METHOD The longitudinal study included 353 individuals from the International CDKL5 Disorder Database with any anthropometric measurement in baseline and/or follow-up questionnaires. The British 1990 growth reference was used to determine the age- and sex-standardized z-score. Repeated cross-sectional data were fitted using a Gaussian linear regression model with generalized estimating equations. RESULTS All growth parameters were below the general population norm (mean z-scores: weight -0.97, height -0.65, body mass index [BMI] -0.81, head circumference -2.12). The disparity was particularly pronounced for all anthropometric measurements after 4 years of age except for BMI. Moreover, individuals with gastrostomy placement were shown to have a larger decrease than those without. INTERPRETATION In addition to weight, height, and BMI, head circumference was also compromised in this disorder. Microcephaly could be considered a helpful diagnostic feature, especially in adults. Any benefit of gastrostomy on weight and BMI was mainly seen in the early years.
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Affiliation(s)
- Kingsley Wong
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - George Davies
- Department of Paediatric Neurology, University Hospitals Bristol and Weston, Bristol, UK
| | - Helen Leonard
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Jenny Downs
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Mohammed Junaid
- Telethon Kids Institute, Perth, Western Australia, Australia
| | - Sam Amin
- Department of Paediatric Neurology, University Hospitals Bristol and Weston, Bristol, UK
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3
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Fung ACH, Ooi YN, Hui HM, Mok MKY, Chung PHY, Wong KKY. Prophylactic anti-reflux procedure for children undergoing laparoscopic gastrostomy: Rethinking of the routine practice. World J Surg 2024; 48:739-745. [PMID: 38501550 DOI: 10.1002/wjs.12078] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/25/2023] [Accepted: 12/27/2023] [Indexed: 03/20/2024]
Abstract
AIM Laparoscopic gastrostomy is a frequently performed procedure in children requiring long-term enteral nutrition. The role of prophylactic anti-reflux surgery during gastrostomy placements is controversial. The current study aims to evaluate the role of prophylactic anti-reflux procedures during gastrostomy placement. METHODS A retrospective single-center analysis of all children without reflux receiving laparoscopic gastrostomy from January 2005 through December 2021 was performed. Demographics and clinical outcomes were compared between patients receiving gastrostomy placement alone and patients receiving gastrostomy with prophylactic anti-reflux surgery. RESULTS A total of 79 patients had a confirmed absence of reflux by a 24-h pH/impedance study before operation. Thirty-six of these patients underwent prophylactic anti-reflux surgery (PAR) while 43 received gastrostomy (PG) alone. The operative time and conversion rate were significantly higher in the PAR group (140.5 ± 67.5 vs. 80.2 ± 66.8 min, p = 0.0001 and 8.3% vs. 0%, p = 0.04). There were no major complications in either group. De novo reflux was detected in five patients (11.6%) in the PG group. None of these patients progressed to require anti-reflux surgery. CONCLUSION The occurrence of de novo reflux after laparoscopic gastrostomy was low and could be managed without anti-reflux surgery. A routine pre-operative pH study is helpful for appropriate patient selection to avoid unnecessary anti-reflux surgery, which lengthens operative time and increases the conversion rate.
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Affiliation(s)
- Adrian Chi Heng Fung
- Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Yu Ning Ooi
- Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Ho Ming Hui
- Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Michelle Kam Yan Mok
- Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Patrick Ho Yu Chung
- Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
| | - Kenneth Kak Yuen Wong
- Department of Surgery, School of Clinical Medicine, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong, Hong Kong
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4
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Walker S, Johnson TW, Carter H, Spurlock AY, Johnson K, Hussey J. Blenderized food tube feeding in very young pediatric patients with special healthcare needs. Nutr Clin Pract 2024; 39:202-209. [PMID: 36871186 DOI: 10.1002/ncp.10975] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/15/2022] [Revised: 01/18/2023] [Accepted: 02/05/2023] [Indexed: 03/06/2023] Open
Abstract
BACKGROUND Up to 85% of children with severe developmental disabilities have feeding disorders and require enteral tube feeding. Many caregivers desire blenderized tube feeding (BTF) instead of commercial formula (CF) for their child, citing a desire for a more physiologic feeding, to reduce gastrointestinal (GI) symptoms and/or promote oral intake. METHODS In this retrospective, single-center study, medical records (n = 34) of very young children (aged ≤36 months) with severe developmental disabilities were reviewed. Comparisons of growth parameters, GI symptoms, oral feeding, and GI medication use were made between the initial introduction of BTF and again at the last patient encounter when the children aged out of the program. RESULTS Of the 34 charts reviewed (16 male and 18 female patients), comparisons between baseline BTF introduction and the last patient encounter indicated reductions in adverse GI symptoms, significant GI medication reduction (P = 0.000), increased oral food intake, and nonsignificant improvements in growth parameters. These positive outcomes were realized whether children received full or partial BTF or type of BTF formulation. CONCLUSION Consistent with similar research studies, transitioning very young children with significant special healthcare needs from CF to BTF resulted in improvement in GI symptoms, reduced need for GI medications, supported growth goals, and contributed to improved oral feeding.
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Affiliation(s)
- Shawna Walker
- The Resource Exchange, Colorado Springs, Colorado, USA
| | - Teresa W Johnson
- Kinesiology & Health Promotion, Troy University, Troy, Alabama, USA
| | - Holly Carter
- Kinesiology & Health Promotion, Troy University, Troy, Alabama, USA
| | - Amy Y Spurlock
- School of Nursing, Boise State University, Boise, Idaho, USA
| | - Kelly Johnson
- Kinesiology & Health Promotion, Troy University, Troy, Alabama, USA
| | - Jenna Hussey
- Kinesiology & Health Promotion, Troy University, Troy, Alabama, USA
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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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Junaid M, Slack-Smith L, Wong K, Hewitt T, Glasson E, Bourke J, Baynam G, Calache H, Leonard H. Hospitalizations from Birth to 28 Years in a Population Cohort of Individuals Born with Five Rare Craniofacial Anomalies in Western Australia. J Pediatr 2023; 259:113418. [PMID: 37030611 DOI: 10.1016/j.jpeds.2023.113418] [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: 07/05/2022] [Revised: 03/29/2023] [Accepted: 03/31/2023] [Indexed: 04/10/2023]
Abstract
OBJECTIVE To describe trends, age-specific patterns, and factors influencing hospitalizations for 5 rare craniofacial anomalies (CFAs). METHODS Data on livebirths (1983-2010; n = 721 019) including rare CFA (craniofacial microsomia, mandibulofacial dysostosis, Pierre Robin sequence, Van der Woude syndrome, and frontonasal dysplasia), episodes of death, and demographic and perinatal factors were identified from the Western Australian Register of Developmental Anomalies, Death Registrations and Midwives Notification System. Information on incident craniofacial and noncraniofacial related admissions, length of hospital stay, and intensive care and emergency-related admissions were identified using principal diagnosis and procedural codes were extracted from the Hospital Morbidity Data Collection and linked to other data sources. Associations of hospitalizations by age groups as well as demographic and perinatal factors were expressed as incidence rate ratio (IRR). RESULTS The incident hospitalizations were 3 times as high for rare CFA (IRR 3.22-3.72) throughout childhood into adolescence than those without. Children with rare CFA had 3-4 times as many potentially preventable hospitalizations until 18 years of age than those without. Specifically, respiratory infections (IRR 2.13-2.35), ear infections (IRR 7.92-26.28), and oral health-related conditions contributed for most noncraniofacial admissions until the adolescence period. A greater incidence of noncraniofacial related hospitalizations was observed among Indigenous children, births with intrauterine growth restrictions, and families with high socioeconomic disadvantage. CONCLUSIONS Throughout childhood, individuals with rare CFA had greater hospital service use, specifically for potentially preventable conditions, than those without. These population-level findings can inform new preventive strategies and early disease management targeted toward reducing preventable hospitalizations.
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Affiliation(s)
- Mohammed Junaid
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia; Telethon Kids Institute, The University of Western Australia, Northern Entrance, Nedlands, Western Australia, Australia.
| | - Linda Slack-Smith
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia; Telethon Kids Institute, The University of Western Australia, Northern Entrance, Nedlands, Western Australia, Australia
| | - Kingsley Wong
- Telethon Kids Institute, The University of Western Australia, Northern Entrance, Nedlands, Western Australia, Australia
| | - Timothy Hewitt
- Department of Plastic and Reconstructive Surgery, Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Emma Glasson
- Telethon Kids Institute, The University of Western Australia, Northern Entrance, Nedlands, Western Australia, Australia
| | - Jenny Bourke
- Telethon Kids Institute, The University of Western Australia, Northern Entrance, Nedlands, Western Australia, Australia
| | - Gareth Baynam
- Telethon Kids Institute, The University of Western Australia, Northern Entrance, Nedlands, Western Australia, Australia; Western Australian Register of Developmental Anomalies, Department of Health, Government of Western Australia, Perth, Western Australia, Australia
| | - Hanny Calache
- Deakin Health Economics, Institute of Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, Victoria, Australia; Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Northern Entrance, Nedlands, Western Australia, Australia; UWA Centre of Child Health Research, University of Western Australia, Nedlands, Western Australia, Australia
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McCormack S, Patel K, Smith C. Blended diet for enteral tube feeding in young people: A systematic review of the benefits and complications. J Hum Nutr Diet 2023; 36:1390-1405. [PMID: 36692240 DOI: 10.1111/jhn.13143] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/22/2022] [Accepted: 01/16/2023] [Indexed: 01/25/2023]
Abstract
BACKGROUND Interest and use of blended diets (BD) for young people who are tube fed has significantly increased in the last decade, driven primarily by the desires of motivated caregivers. This review identified, appraised and synthesised the available evidence on the benefits and complications of BD versus commercial feeds. METHODS A systematic review following PRISMA guidance and registered with PROSPERO was conducted across PubMed, Embase, CINAHL, Scopus and Cochrane up to August 2022. INCLUSION CRITERIA English language studies including (1) children, (2) original research (interventional and observational) and (3) examination of BD outcomes. Exclusion criteria were (1) unoriginal research or case reports, (2) focus on feeding management, preparations or attitudes and (3) comparing commercial blends only. Data were synthesised using an established narrative synthesis approach using the Mixed Methods Appraisal Tool. RESULTS Eight hundred and six database results were identified and 61 were sought for retrieval. A full-text article review revealed seven eligible studies, involving 267 participants (age range 9 months to 26 years). Studies reported differences in gastrointestinal symptoms (n = 222), medication use (n = 119), growth (n = 189) and complications or adverse events (n = 91). The results indicate positive outcomes, particularly in gastrointestinal symptom control, with few reports of mild adverse events in the included studies. CONCLUSIONS There is a paucity of data in this area and much heterogeneity in the included studies, but the available literature points towards positive outcomes. This is an important and highly relevant topic, and more primary research, ideally using standardised reporting, is required to answer the key questions.
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Affiliation(s)
- Siobhan McCormack
- Department of Paediatrics, Brighton and Sussex Medical School, Brighton, UK
- Department of Child Development and Neurodisability, Children's Health Ireland at Tallaght, Dublin, Ireland
| | - Kamal Patel
- Department of Paediatrics, Brighton and Sussex Medical School, Brighton, UK
- Department of Paediatrics, Royal Alexandra Children's Hospital, Brighton, UK
| | - Chris Smith
- Department of Paediatric Dietetics, Royal Alexandra Children's Hospital, Brighton, UK
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Popescu M, Mutalib M. Rate of paediatric gastrostomy insertion in England and relationship to epidemiology of cerebral palsy. Frontline Gastroenterol 2023; 14:399-406. [PMID: 37581183 PMCID: PMC10423607 DOI: 10.1136/flgastro-2022-102356] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/20/2022] [Accepted: 04/24/2023] [Indexed: 08/16/2023] Open
Abstract
Background and objectives Gastrostomy tubes are commonly used to provide an alternative route for enteral nutrition. Most of the gastrostomies are inserted in children with cerebral palsy. Previous studies have shown an increase in insertion rate, however, epidemiological studies reveal a stasis in prevalence of cerebral palsy. We aimed to provide an up-to-date rate of gastrostomy insertion in children in England over a 20-year period and systematically review the prevalence of cerebral palsy to ascertain an epidemiological explanation for insertion trends. Methods Retrospective search of Hospital Episode Statistic, a database held diagnosis and procedural code from all England National Health Service hospitals from 2000 to 2021 using International Classification of Disease-10 and Office of Population Censuses and Survey's Classification-4. England Office for National Statistics data were used for population census. MEDLINE and EMBASE were systematically searched for epidemiology of cerebral palsy. Results There were 23 079 gastrostomies inserted in children <15 years in England (2000-2021) leading to a frequency of 12.4 insertions per 100 000 children per year and 1383 gastrostomy insertions in 15-18 years age group (6 per 100 000). The overall gastrostomy insertion rate in children <15 years has increased from 3.7 procedures per 100 000 in 2000 to 18.3 per 100 000 in 2017. Prevalence of cerebral palsy remained stable (1.5-3.3 per 1000 birth) since 1985. Conclusions There was a significant increase in the rate of gastrostomy insertion in children in England during most of the last 20 years not explained by a stable prevalence of cerebral palsy.
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Affiliation(s)
- Mara Popescu
- Faculty of Life Sciences and Medicine, King's College London, London, UK
| | - Mohamed Mutalib
- Faculty of Life Sciences and Medicine, King's College London, London, UK
- Evelina London Children's Hospital, London, UK
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Shrager S, Adigun A, Motolongo S, Santos CS, Rowe-King P, Duro D. Comparison of Home-Blenderized Formula and Commercial Enteral Formulas for Gastrostomy Tube-Fed Children: A Retrospective, Prospective Cohort Study. Cureus 2023; 15:e37944. [PMID: 37220453 PMCID: PMC10200265 DOI: 10.7759/cureus.37944] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 04/21/2023] [Indexed: 05/25/2023] Open
Abstract
Background Blenderized gastrostomy tube feedings (BGTFs) consist of pureed table foods and liquids that are administered as enteral tube feedings. Compared to commercial enteral formulas (CEFs), BGTF has been shown to have fewer side effects. Despite these results, apprehensions have been raised about microbial contamination, nutritional deficiencies or surplus, risk of gastrostomy tube (GT) blockages, and lack of consistency in clinical outcomes. The goal of this retrospective, prospective, 18-month-long study is to report the clinical and nutritional outcomes of GT-dependent pediatric patients who attended a multidisciplinary feeding clinic. Methodology After Institutional Review Board (IRB) approval and consent were obtained, 25 children who were receiving tube feeding via G were enrolled in a retrospective, prospective, observational, cohort study from August 2019 to February 2021. A multidisciplinary team was formed, and multivariate logistic regression was performed comparing subjects on BGTF versus CEF, per os diet versus nil per os, CEF versus homemade blenderized tube feeding (HBTF) versus blenderized tube feeding (BTF), and how they compared at the beginning and end of the study. Results The mean age of the patients was 4.4 years (SD ±2.2). Gastroesophageal reflux disease (GERD) and short bowel syndrome (SBS) were the most common comorbid gastrointestinal (GI) conditions. Of the 25 patients enrolled in the study, seven were initially on BGTF, while 14 ended the study on BGTF. There were no statistically significant differences in malnutrition status, feeding intolerance, emergency room visits, hospitalizations, and GT blockages between all different comparison groups when comparing between the CEF versus HBTF versus commercial blenderized tube feeding (CBTF) groups. Of the patients who were in the BGTF group, there was a resolution of vitamin A deficiency, vitamin D deficiency, and anemia (n = 1). In total, two patients had resolved vitamin deficiencies, namely, vitamins A and D. Conclusions When comparing BGTF and CEF, there was no statistically significant difference in outcomes. This study suggests that BGTF is at least equivalent to CEF in clinical outcomes, meaning BGTF should be considered standard nutrition for GT-dependent patients.
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Affiliation(s)
- Sebastian Shrager
- Pediatrics, Salah Foundation Children's Hospital at Broward Health Medical Center, Fort Lauderdale, USA
| | - Ayoola Adigun
- Pediatrics, Salah Foundation Children's Hospital at Broward Health Medical Center, Fort Lauderdale, USA
| | - Sonia Motolongo
- Pediatrics, Salah Foundation Children's Hospital at Broward Health Medical Center, Fort Lauderdale, USA
| | - Cristhiane S Santos
- Pediatrics, Salah Foundation Children's Hospital at Broward Health Medical Center, Fort Lauderdale, USA
| | - Patricia Rowe-King
- Pediatrics, Salah Foundation Children's Hospital at Broward Health Medical Center, Fort Lauderdale, USA
| | - Debora Duro
- Pediatric Gastroenterology, Salah Foundation Children's Hospital at Broward Health Medical Center, Fort Lauderdale, USA
- Pediatrics, Nova Southeastern University Dr. Kiran C. Patel College of Osteopathic Medicine, Fort Lauderdale, USA
- Pediatrics, Florida International University, Herbert Wertheim College of Medicine, Miami, USA
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Junaid M, Slack-Smith L, Wong K, Hewitt T, Bourke J, Baynam G, Calache H, Leonard H. Patterns, trends, and factors influencing hospitalizations for craniosynostosis in Western Australia. A population-based study. Eur J Pediatr 2023; 182:2379-2392. [PMID: 36899143 PMCID: PMC10175457 DOI: 10.1007/s00431-023-04922-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/24/2022] [Revised: 03/01/2023] [Accepted: 03/03/2023] [Indexed: 03/12/2023]
Abstract
Understanding hospital service use among children with a diagnosis of craniosynostosis (CS) is important to improve services and outcomes. This study aimed to describe population-level trends, patterns, and factors influencing hospitalizations for craniosynostosis in Western Australia. Data on live births (1990-2010; n = 554,624) including craniosynostosis, episodes of death, demographic, and perinatal factors were identified from the midwives, birth defects, hospitalizations, and death datasets. Information on craniosynostosis and non-craniosynostosis-related admissions, cumulative length of hospital stay (cLoS), intensive care unit, and emergency department-related admissions were extracted from the hospitalization dataset and linked to other data sources. These associations were examined using negative binomial regression presented as annual percent change and associations of hospitalizations by age groups, demographic, and perinatal factors were expressed as incidence rate ratio (IRR). We found an increasing trend in incident hospitalizations but a marginal decline in cLoS for craniosynostosis over the observed study period. Perinatal conditions, feeding difficulties, nervous system anomalies, respiratory, and other infections contributed to majority of infant non-CS-related admissions.Respiratory infections accounted for about twice the number of admissions for individuals with CS (IRRs 1.94-2.34) across all observed age groups. Higher incidence of non-CS hospitalizations was observed among females, with associated anomalies, to families with highest socioeconomic disadvantage and living in remote areas of the state. Conclusion: Marginal reduction in the cLoS for CS-related admissions observed over the 21-year period are potentially indicative of improved peri-operative care. However, higher incidence of respiratory infection-related admissions for syndromic synostosis is concerning and requires investigation.
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Affiliation(s)
- Mohammed Junaid
- School of Population and Global Health, The University of Western Australia, Clifton Street Building, Clifton Street, Nedlands, 6009, WA, Australia. .,Telethon Kids Institute, The University of Western Australia, Northern Entrance, 15 Hospital Avenue, Nedlands, WA, Australia.
| | - Linda Slack-Smith
- School of Population and Global Health, The University of Western Australia, Clifton Street Building, Clifton Street, Nedlands, 6009, WA, Australia.,Telethon Kids Institute, The University of Western Australia, Northern Entrance, 15 Hospital Avenue, Nedlands, WA, Australia
| | - Kingsley Wong
- Telethon Kids Institute, The University of Western Australia, Northern Entrance, 15 Hospital Avenue, Nedlands, WA, Australia
| | - Timothy Hewitt
- Department of Plastic and Reconstructive Surgery, Perth Children's Hospital, Nedlands, WA, Australia
| | - Jenny Bourke
- Telethon Kids Institute, The University of Western Australia, Northern Entrance, 15 Hospital Avenue, Nedlands, WA, Australia
| | - Gareth Baynam
- Western Australian Register of Developmental Anomalies, Department of Health, Government of Western Australia, Perth, WA, Australia
| | - Hanny Calache
- Deakin Health Economics, Institute of Health Transformation, School of Health and Social Development, Faculty of Health, Deakin University, Geelong, VIC, Australia.,Department of Dentistry and Oral Health, La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | - Helen Leonard
- Telethon Kids Institute, The University of Western Australia, Northern Entrance, 15 Hospital Avenue, Nedlands, WA, Australia
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Williams MD, Skertich N, Sullivan GA, Harmon K, Madonna MB, Pillai S, Shah AN, Gulack BC. Prophylactic antireflux procedures are not necessary in neurologically impaired children undergoing gastrostomy placement. Pediatr Surg Int 2023; 39:122. [PMID: 36786900 DOI: 10.1007/s00383-023-05398-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 01/31/2023] [Indexed: 02/15/2023]
Abstract
PURPOSE Fundoplication is frequently used in children with neurologic impairment even in the absence of reflux due to concerns for future gastric feeding intolerance, but supporting data are lacking. We aimed to determine the incidence of secondary antireflux procedures (fundoplication or gastrojejunostomy (GJ)) post gastrostomy tube (GT) placement in children with and without neurologic impairment. METHODS Children under 18 undergoing a GT placement without fundoplication between 2010 and 2020 were identified utilizing the PearlDiver Mariner national patient claims database. Children with a diagnosis of cerebral palsy or a degenerative neurologic disease were identified and compared to children without these diagnoses. The incidence of delayed fundoplication or conversion to GJ were compared utilizing Kaplan-Meier and Cox proportional hazards regression analyses. RESULTS A total of 14,965 children underwent GT placement, of which 3712 (24.8%) had a diagnosis of neurologic impairment. The rate of concomitant fundoplication was significantly higher among children with a diagnosis of neurologic impairment as compared to those without (9.3% vs 6.4%, p < 0.001). While children with neurologic impairment had a significantly higher rate of fundoplication or GJ conversion at 5 years compared to children without (12.6% [95% confidence interval (CI): 11.4%-13.8%] vs 8.6% [95% CI 8.0%-9.2%], p < 0.001), the overall incidence remained low. CONCLUSION Although children with neurologic impairment have a higher rate of requiring an antireflux procedure or GJ conversion than other children, the overall rate remains less than 15%. Fundoplication should not be utilized in children without clinical reflux on the basis of neurologic impairment alone.
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Affiliation(s)
- Michael D Williams
- Department of Surgery, Division of Pediatric Surgery, Rush University Medical Center, 1750 W. Harrison, Suite 785, Chicago, IL, 60612, USA
| | - Nicholas Skertich
- Department of Surgery, Division of Pediatric Surgery, Rush University Medical Center, 1750 W. Harrison, Suite 785, Chicago, IL, 60612, USA
| | - Gwyneth A Sullivan
- Department of Surgery, Division of Pediatric Surgery, Rush University Medical Center, 1750 W. Harrison, Suite 785, Chicago, IL, 60612, USA
| | - Kelly Harmon
- Department of Surgery, Division of Pediatric Surgery, Rush University Medical Center, 1750 W. Harrison, Suite 785, Chicago, IL, 60612, USA
| | - Mary Beth Madonna
- Department of Surgery, Division of Pediatric Surgery, Rush University Medical Center, 1750 W. Harrison, Suite 785, Chicago, IL, 60612, USA
| | - Srikumar Pillai
- Department of Surgery, Division of Pediatric Surgery, Rush University Medical Center, 1750 W. Harrison, Suite 785, Chicago, IL, 60612, USA
| | - Ami N Shah
- Department of Surgery, Division of Pediatric Surgery, Rush University Medical Center, 1750 W. Harrison, Suite 785, Chicago, IL, 60612, USA
| | - Brian C Gulack
- Department of Surgery, Division of Pediatric Surgery, Rush University Medical Center, 1750 W. Harrison, Suite 785, Chicago, IL, 60612, USA.
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12
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Makker J, Pardy C, Kelly V, Yardley I. The Community Cost of Maintaining Gastrostomies in Pediatric Patients. JPGN REPORTS 2023; 4:e278. [PMID: 37181922 PMCID: PMC10174736 DOI: 10.1097/pg9.0000000000000278] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/04/2022] [Accepted: 12/08/2022] [Indexed: 05/16/2023]
Abstract
The use of gastrostomies in children is increasing and their need for long-term management following insertion presents a potentially significant financial and resource challenge to local healthcare systems. Objectives The aim of this study was to determine the yearly cost of maintaining a gastrostomy in a pediatric patient. Methods A retrospective, bottom-up cost-analysis was conducted in a cohort of 180 patients with gastrostomies aged 0-19 years. One in 5 patients were randomly selected for individual cost analysis (n = 36). Their electronic health record was interrogated from the period of March 1, 2019-March 1, 2020. Costs included in the analysis were staff contact time from the community nursing and nutrition teams, and equipment costs. Results The mean cost of maintaining a pediatric gastrostomy across all ages was £709.87 (SD 403.18) per year. Mean annual cost varied by age, underlying diagnosis, and gastrostomy device, but this variation was only statistically significant for the type of device, with Mic-Key buttons having a mean annual cost of £834.66 (SD 307.85), Mini buttons £799.06 (SD 395.01), and percutaneous endoscopic gastrostomy tubes £279.34 (SD 297.45; P = 0.004). Conclusion The mean cost of maintaining a gastrostomy in a pediatric patient is just over £700 per year. The cost is the highest as a child enters adulthood. Button devices have higher maintenance costs compared with percutaneous endoscopic gastrostomy tubes.
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Affiliation(s)
- Jasmine Makker
- From the GKT School of Medical Education, King’s College London, London, United Kingdom
| | - Caroline Pardy
- Department of Paediatric Surgery, Evelina London Children’s Hospital, London, United Kingdom
| | - Veronica Kelly
- Department of Paediatric Neurosciences, Evelina London Children’s Hospital, London, United Kingdom
- The Mary Sheridan Centre, Evelina London Children’s Community Services, London, United Kingdom
| | - Iain Yardley
- From the GKT School of Medical Education, King’s College London, London, United Kingdom
- Department of Paediatric Surgery, Evelina London Children’s Hospital, London, United Kingdom
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13
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Dougherty D, Rubalcava NS, Janke OG, Speck KE, Johnson KN, Jarboe MD. Ultrasound-Guided Gastrostomy Tube Placement: An Evaluation of Postoperative Complications in the Pediatric Population. J Laparoendosc Adv Surg Tech A 2022; 32:902-906. [PMID: 35671516 DOI: 10.1089/lap.2021.0752] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
Background: Using ultrasound guidance has been demonstrated as a feasible alternative method for gastrostomy tube placement in the pediatric population. The aim of this study is to evaluate short- and long-term postoperative complications after ultrasound-guided gastrostomy tube placement (USGTP) and to compare them with complications after laparoscopic gastrostomy tube placement (LGTP). Methods: A retrospective chart review evaluated patients who underwent USGTP (n = 41) and LGTP (n = 120) at the same institution. Comparisons were made between the two groups in the context of demographics as well as 30-day and 6-month postoperative complications. A phone survey (n = 26) further identified USGTP complications potentially not captured in the electronic medical records. Results: There were no significant differences in age, gender, and indication for procedure between the two groups. Chart review revealed that USGTP and LGTP had statistically comparable rates of emergency department (ED) visits for postoperative complications. Among USGTP patients, 8% had a recorded ED visit within 30 days of the operation and 13% presented to the ED within 6 months, compared with 6% and 11%, respectively, in the LGTP group (P = .65, P = .69). The USGTP phone survey reported total complications over an average postoperative follow-up time of 34.6 months (range 8-87) and revealed a total ED visit rate of 35%, which is comparable with rates reported in the literature for minimally invasive feeding tube placement. Conclusion: USGTP is a safe and feasible alternative option for gastrostomy tube placement in the pediatric population and it has postoperative complication rates that are comparable with LGTP.
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Affiliation(s)
- Danielle Dougherty
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Nathan S Rubalcava
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Olivia G Janke
- College of Osteopathic Medicine, Michigan State University, East Lansing, Michigan, USA
| | - K Elizabeth Speck
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Kevin N Johnson
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USA
| | - Marcus D Jarboe
- Section of Pediatric Surgery, Department of Surgery, University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USA.,Department of Radiology, University of Michigan, Michigan Medicine, Ann Arbor, Michigan, USA
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14
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Marpole R, Langdon K, Wilson A. Gastrostomy feeding in children with severe cerebral palsy in Western Australia. Acta Paediatr 2022; 111:680-681. [PMID: 34905225 DOI: 10.1111/apa.16214] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/26/2021] [Revised: 09/28/2021] [Accepted: 12/13/2021] [Indexed: 11/28/2022]
Affiliation(s)
- Rachael Marpole
- Respiratory and Sleep Medicine CAHS Nedlands WA Australia
- Department of Paediatrics University of Western Australia Perth WA Australia
| | - Katherine Langdon
- Kid’s Rehab WACAHS Nedlands WA Australia
- Telethon Kids Institute Nedlands WA Australia
| | - Andrew Wilson
- Respiratory and Sleep Medicine CAHS Nedlands WA Australia
- Department of Paediatrics University of Western Australia Perth WA Australia
- Wal‐Yan Respiratory Research CentreTelethon Kids Institute Nedlands WA Australia
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15
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Naji H, Gheewale A, Safi E, Tuma F. Assessing clinical outcomes of modified laparoscopic gastrostomy in children: a case control study. BMC Surg 2022; 22:61. [PMID: 35193601 PMCID: PMC8862243 DOI: 10.1186/s12893-022-01515-0] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2021] [Accepted: 02/10/2022] [Indexed: 11/10/2022] Open
Abstract
Background With gastrostomy becoming a common surgical procedure within the pediatric population surgeons continued to introduce modifications on the procedure to overcome some of the challenges and minimize complications. Modified U-stitches laparoscopic gastrostomy is gaining favor in some centers including the center of this study. Hence, this study was conducted to evaluate and compare its outcomes. Methods Eighty-nine gastrostomy procedures performed between 2013 and 2020 were reviewed to evaluate the surgical outcomes of a novel modified U-stitches laparoscopic gastrostomy (MLG) to the standard laparoscopic gastrostomy (LG) in children. The main outcome measured is the rate of postoperative complications encompassing dislodgement of gastrostomy button, leak around button, local infection, and development of granulation tissue post-surgery which is compared between the two population groups. Results The rate of leak around the button was found to be significantly less in the MLG (4%) compared to (15%) in the traditional LG approach with a p-value of 0.03. However, the overall complication rate for MGL is 63%; while it is 73% for LG. Conclusions The modified U-stitches laparoscopic gastrostomy has a lower rate of complications in comparison to the standard laparoscopic gastrostomy making it a preferred technique for gastrostomy placement in children.
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Affiliation(s)
- Hussein Naji
- Mediclinic Parkview Hospital, Dubai, UAE.,Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | - Aafia Gheewale
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE.
| | - Ebtesam Safi
- Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai, UAE
| | - Faiz Tuma
- Central Michigan University College of Medicine, Mount Pleasant, MI, USA.,Western Michigan University Homer Stryker M.D. School of Medicine, Kalamazoo, MI, USA
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16
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Junaid M, Slack-Smith L, Wong K, Baynam G, Calache H, Hewitt T, Leonard H. Epidemiology of Hospital Admissions for Craniosynostosis in Australia: A Population-Based Study. Cleft Palate Craniofac J 2022; 60:569-576. [PMID: 35130078 DOI: 10.1177/10556656221074215] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2023] Open
Abstract
To describe trends, age, and sex-specific patterns of population hospital admissions with a diagnosis of craniosynostosis (CS) in Australia. Population data for hospital separations (in-patient) from public and private hospitals (July 1996-June 2018) were obtained from the publicly available Australian Institute of Health and Welfare (AIHW) National Hospital Morbidity Database. The outcome variables were hospital separation rates (HSR) (number of hospital separations divided by the estimated resident population [ERP] per year) and average length of stay (aLOS) (patient days divided by the number of hospital separations) with a diagnosis of CS. Trends in HSR and aLOS adjusted for age, sex, and type of CS were investigated by negative binomial regression presented as annual percent change (APC). In 8057 admissions identified, we observed no significant change in the annual trend for HSR for the 22-year period. However, a marginal annual decrease of 1.6% (95% CI: -0.7, -2.4) in the aLOS was identified for the same time period. HSR were higher for males, infants, and single suture synostosis. aLOS was 3.8 days (95% CI: 3.8, 3.9) per visit, longer for syndromic conditions. There was a minor reduction in the average length of hospital stay for CS over the 22-year period potentially indicative of improved care. Population-level information on hospitalisations for rare craniofacial conditions can inform research, clinical, and surgical practice.
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Affiliation(s)
- Mohammed Junaid
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia.,117610Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Linda Slack-Smith
- School of Population and Global Health, The University of Western Australia, Nedlands, Western Australia, Australia.,117610Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Kingsley Wong
- 117610Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia
| | - Gareth Baynam
- 117610Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia.,Department of Health, 569007Genetic Services of Western Australia, Perth, Western Australia, Australia
| | - Hanny Calache
- School of Health and Social Development, Faculty of Health, Deakin Health Economics, Institute of Health Transformation, 91844Deakin University, Geelong, Victoria, Australia.,Department of Dentistry and Oral Health, 56371La Trobe Rural Health School, La Trobe University, Bendigo, Victoria, Australia
| | - Timothy Hewitt
- Department of Plastic Surgery, 60081Perth Children's Hospital, Nedlands, Western Australia, Australia
| | - Helen Leonard
- 117610Telethon Kids Institute, The University of Western Australia, Nedlands, Western Australia, Australia.,Faculty of Health and Medical Sciences, Centre of Child Health Research, University of Western Australia, Nedlands, Western Australia, Australia
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17
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Epidemiology of Rare Craniofacial Anomalies: Retrospective Western Australian Population Data Linkage Study. J Pediatr 2022; 241:162-172.e9. [PMID: 34626670 DOI: 10.1016/j.jpeds.2021.09.060] [Citation(s) in RCA: 13] [Impact Index Per Article: 6.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/19/2021] [Revised: 09/08/2021] [Accepted: 09/30/2021] [Indexed: 01/10/2023]
Abstract
OBJECTIVE To describe birth prevalence of rare craniofacial anomalies and associations with antenatal and perinatal factors. STUDY DESIGN All live and stillbirths in Western Australia between 1980 and 2010 were identified from the Western Australian Birth Registrations and the Midwives Notification System (also provides information on antenatal and perinatal factors). Rare craniofacial anomalies (craniosynostosis, craniofacial microsomia, and others [Pierre Robin, Van der Woude, and Treacher Collins syndrome]) were ascertained from the Western Australian Register of Developmental Anomalies and linked to other data sources. Trends in prevalence, adjusted for sex and Indigenous status, were investigated by Poisson regression and presented as annual percent change (APC). Strengths of association of related factors were assessed using multivariable log-binomial regression adjusted for sex, Indigenous status, birth year, socioeconomic disadvantage, and remoteness and reported as risk ratios with 95% CIs. RESULTS There was a temporal increase in prevalence of metopic synostosis (APC 5.59 [2.32-8.96]) and craniofacial microsomia (Goldenhar syndrome) (APC 4.43 [1.94-6.98]). Rare craniofacial anomalies were more likely among infants born preterm, as twins or greater-order multiples, with growth restriction, to older parents, to mothers undertaking fertility treatments, and with pre-existing medical conditions, specifically epilepsy, diabetes, or hypothyroidism. Prenatal identification of rare craniofacial anomalies was uncommon (0.6%). CONCLUSIONS Our findings indicate a steady increase over time in prevalence of metopic synostosis and craniofacial microsomia (Goldenhar syndrome). Possible associations of fertility treatments and pre-existing maternal medical conditions with rare craniofacial anomalies require further investigation.
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18
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Demirel BD, Yagiz B, Hancioglu S, Caltepe G. Comparing Different Techniques in Children With or Without a Simultaneous Fundoplication: Does the Gastrostomy Technique Matter? J Laparoendosc Adv Surg Tech A 2021; 31:1067-1072. [PMID: 34525317 DOI: 10.1089/lap.2021.0049] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Purpose: To evaluate the results of different gastrostomy techniques and the impact of simultaneous fundoplication. Materials and Methods: The patients who underwent a gastrostomy procedure between 2009 and 2019 in a single tertiary center were evaluated retrospectively. The patients are divided into groups depending on the gastrostomy techniques as open gastrostomy (OG), laparoscopic gastrostomy (LG), percutaneous endoscopic gastrostomy (PEG), and laparoscopy-assisted PEG (LAPEG). Preoperative characteristics and postoperative outcomes are compared among the groups. Results: Two hundred forty-four patients (75, 60, 91, and 18 patients in OG, LG, PEG, and LAPEG groups, respectively) are enrolled in the study. Although rates of minor or major complications did not demonstrate a significant difference among the groups, no major complications were encountered in the LAPEG group, while the lowest minor complications were observed in the PEG group (P > .05). Length of postoperative initiation of enteral feeding and length of hospital stay (LOS) were highest in the OG group (P = .000). Performing a concurrent fundoplication procedure significantly delayed the initiation of enteral feeding and increased the LOS in all of the groups (P < .005). Conclusions: Although PEG is a safe and reproducible technique of gastrostomy in selected patients, LAPEG may expand the boundaries of PEG by reducing the major complication rates. Although simultaneous fundoplication may complicate the perioperative period, it does not have significance on outcomes.
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Affiliation(s)
- Berat Dilek Demirel
- Department of Pediatric Surgery, Ondokuz Mayıs University Medical School, Samsun, Turkey
| | - Beytullah Yagiz
- Department of Pediatric Surgery, Ondokuz Mayıs University Medical School, Samsun, Turkey
| | - Sertac Hancioglu
- Department of Pediatric Surgery, Ondokuz Mayıs University Medical School, Samsun, Turkey
| | - Gonul Caltepe
- Department of Pediatric Gastroenterology, Hepatology and Nutrition, Ondokuz Mayıs University Medical School, Samsun, Turkey
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19
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Junaid M, Slack-Smith L, Wong K, Baynam G, Calache H, Hewitt T, Leonard H. Description of Total Population Hospital Admissions for Treacher Collins Syndrome in Australia. Cleft Palate Craniofac J 2021; 59:1167-1175. [PMID: 34410170 DOI: 10.1177/10556656211036618] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/15/2022] Open
Abstract
OBJECTIVE To describe patterns and demographic characteristics of total-population hospital admissions with a diagnosis of Treacher Collins syndrome (TCS) in Australia. DATA SOURCE Population summary data for inpatient hospitals admissions (public and private) with a principal diagnosis of TCS (ICD10-AM-Q87.04) were obtained from the Australian Institute of Health and Welfare National Hospital Morbidity Database for a 11-year period (2002-2013). MAIN OUTCOME MEASURES The primary outcome was hospital separation rate (HSR), calculated by dividing the number of hospital separations by estimated resident population per year. Trends in HSR s adjusted for age and sex were investigated by negative binomial regression presented as annual percent change and the association of rates with age and sex was expressed as incidence rate ratio. RESULTS In 244 admissions identified, we observed an increase of 4.55% (95% confidence interval [CI] -1.78, 11.29) in HSR's over the 11-year period. Rates were higher during infancy (1.87 [95% CI 1.42, 2.42]), declining markedly with increasing age. The average length of hospital stay was 6.09 days (95% CI 5.78, 6.40) per episode, but longer for females and infants. CONCLUSIONS Findings indicate an increase in hospitalization rates, especially among infants and females which potentially relates to early airway intervention procedures possibly influenced by sex specific-disease severity and phenotypic variability of TCS. Awareness of the TCS phenotype and improved access to genetic testing may support more personalized and efficient care. Total-population administrative data offers a potential to better understand the health burden of rare craniofacial diseases.
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Affiliation(s)
- Mohammed Junaid
- School of Population and Global Health, The University of Western Australia, Nedlands, WA, Australia.,117610Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
| | - Linda Slack-Smith
- School of Population and Global Health, The University of Western Australia, Nedlands, WA, Australia.,117610Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
| | - Kingsley Wong
- 117610Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
| | - Gareth Baynam
- 117610Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia.,569007Genetic Services of Western Australia, Perth, WA, Australia
| | - Hanny Calache
- Institute of Health Transformation, School of Health and Social Development, 91844Deakin University, Geelong, VIC, Australia.,56371La Trobe Rural Health School, La Trobe University, Bendigo, VIC, Australia
| | | | - Helen Leonard
- 117610Telethon Kids Institute, The University of Western Australia, Nedlands, WA, Australia
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20
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Backman E, Granlund M, Karlsson AK. Parental Perspectives on Family Mealtimes Related to Gastrostomy Tube Feeding in Children. QUALITATIVE HEALTH RESEARCH 2021; 31:1596-1608. [PMID: 33666118 PMCID: PMC8438777 DOI: 10.1177/1049732321997133] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/07/2023]
Abstract
Built on the important functions daily routines serve families and child health, this study aimed to explore parents' descriptions of mealtimes and food-related challenges when living with a child using a gastrostomy feeding tube. The study was informed by ecocultural theory and based on in-depth interviews combined with stimulated recall. The interviews of 10 parents were inductively analyzed by means of qualitative content analysis. Four main categories comprised the parents' descriptions: "One situation, different functions," "On the child's terms," "Doing something to me," and "An unpredictable pattern," with one overarching theme. The analyses showed that the parents strived to establish mealtimes in line with their cultural context, although they struggled to reach a point of satisfaction. The study highlights the importance of health care professionals to address the medical aspects of caring for a child with a G-tube, but also the potential psychological and social consequences for ordinary family life.
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Affiliation(s)
- Ellen Backman
- Halmstad University, Halmstad, Sweden
- Region Halland, Kungsbacka, Sweden
- Ellen Backman, School of Health and Welfare, Halmstad University, Box 823, 301 18 Halmstad, Sweden.
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21
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Pardy C, Kharma N, Lau R, Kelly V, Yardley I. Point Prevalence of Gastrostomy in a Paediatric Population. J Pediatr Gastroenterol Nutr 2021; 72:528-531. [PMID: 33306583 DOI: 10.1097/mpg.0000000000003016] [Citation(s) in RCA: 6] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/16/2022]
Abstract
OBJECTIVE The aim of the study was to determine the prevalence of gastrostomy in a paediatric population. METHODS A population-based cross-sectional point prevalence study of paediatric gastrostomy was performed. Patients included were ages 0 to 19 years, living within 3 inner-city London boroughs; Southwark, Lambeth, and Lewisham. Patients were identified as having a gastrostomy in situ via Home Enteral Nutrition (HEN) and community nursing databases. Electronic healthcare records were scrutinised to confirm current use of a gastrostomy. The main outcome measures were the point prevalence of gastrostomy in the paediatric population (gastrostomies/100,000 children), primary diagnosis, indication underlying gastrostomy insertion, and age at insertion. RESULTS The total population studied was 946,709, of whom 213,920 were of age 0 to 19 years. Of these, 179 had a gastrostomy in situ giving a point prevalence for gastrostomy in the paediatric population of 83.7 (95% confidence interval [CI]: 71.4-96.0)/100,000 children. This varied between age groups: 0 to 4 years: 79.6 (57.3-102.0)/100,000, 5 to 9 years: 116.3 (88.7-143.9)/100,000, 10 to 14: years 87.9 (61.9-113.9)/100,000 and 15 to 19: years 41.4 (22.1-60.1)/100,000. The most common primary diagnoses were neurological disorders (57.1%), and structural abnormalities (16.2%). Unsafe swallow was the most common indication (61%), followed by nutritional or fluid supplementation (28.6%), and behavioural reasons (8.7%). The majority (85.1%) of gastrostomies were inserted under the age of 2 years. CONCLUSIONS This is the first UK population-based study of paediatric gastrostomy, identifying a point prevalence of 84/100,000 children. The peak prevalence is in children ages 5 to 9 years. Gastrostomy insertion after a child reaches school age is uncommon.
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Affiliation(s)
- Caroline Pardy
- Department of Paediatric Surgery, Evelina London Children's Hospital
| | | | - Rachel Lau
- GKT King's College London Medical School
| | - Veronica Kelly
- Department of Paediatric Neurosciences, Evelina London Children's Hospital
- Mary Sheridan Centre, Evelina London Children's Community Services, United Kingdom
| | - Iain Yardley
- Department of Paediatric Surgery, Evelina London Children's Hospital
- GKT King's College London Medical School
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22
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Emergency Presentations for Gastrostomy Complications Are Similar in Adults and Children. J Pediatr Gastroenterol Nutr 2021; 72:141-143. [PMID: 32833893 DOI: 10.1097/mpg.0000000000002920] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 01/16/2023]
Abstract
Gastrostomy tube (GT) complications are often managed in the Emergency Department (ED). We aimed to characterize and compare the pattern of ED presentations of GT complications in adults and children. A retrospective chart review of patients with GT complications presenting to 3 Australian EDs in 2 years was undertaken. ED visits for GT complications occurred in 70 GT patients (36 adults, 34 children) with 122 presentations. When comparing adults to children, infections occurred in 21% versus 36%, respectively; P = 0.08, mechanical issues in 48% versus 52%; P = 0.86, vomiting in 23% versus 8%; P = 0.02, and other issues in 7% versus 5%; P = 0.7. Presentation to ED within 28 days of initial GT insertion occurred in 3 (8%) adults and 3 (9%) children, predominantly with tube dislodgement. GT complications seen in ED are predominantly infectious and mechanical in nature, with an increased frequency of vomiting in adults when compared with children.
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23
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Outcomes and Safety of Blenderized Tube Feedings in Pediatric Patients: A Single Center's Experience. J Pediatr Gastroenterol Nutr 2020; 71:e124-e128. [PMID: 32810040 DOI: 10.1097/mpg.0000000000002853] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
INTRODUCTION Recently, significant interest from families and healthcare providers has arisen to use blenderized tube feedings (BTF). Although many institutions are providing this nutritional option, literature documenting outcomes and safety is lacking. METHODS A retrospective chart review was performed on pediatric patients receiving BTF at Rutgers-Robert Wood Johnson University Hospital between January 2013 and April 2017. Demographic data and dietary information before and after BTF were collected. Reasons for diet initiation, symptoms, and anthropometrics were recorded. Adverse events and outcomes were assessed through physician documentation and relevant medication changes. RESULTS Thirty-five patients (24 boys) received BTF. Age at initiation of BTF ranged from 1 to 19 years (mean 8.3 +/- 5.8 [SD] years). Length of follow-up ranged from 1 to 45 months (mean 15 +/- 12.2 months). The most common reason for starting BTF was gastroesophageal reflux disease (GERD) (N = 32). Almost all patients were on medications for GERD, constipation, or gastrointestinal dysmotility before starting BTF (N = 33). Majority of patients had improvement in relevant symptoms (N = 20); 13 of 33 patients on gastrointestinal medications were able to wean or stop medication(s). BMI z scores did not differ before and after BTF initiation (P = 0.558). No serious life-threatening adverse events were found. CONCLUSIONS Our data suggest that BTF is a safe dietary intervention that may improve gastrointestinal symptoms in pediatric patients. Further prospective studies are needed to compare safety and efficacy of BTF and commercial formulas in pediatric patients.
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Glasson EJ, Forbes D, Ravikumara M, Nagarajan L, Wilson A, Jacoby P, Wong K, Leonard H, Downs J. Gastrostomy and quality of life in children with intellectual disability: a qualitative study. Arch Dis Child 2020; 105:969-974. [PMID: 32269039 DOI: 10.1136/archdischild-2020-318796] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/07/2020] [Revised: 02/25/2020] [Accepted: 03/25/2020] [Indexed: 11/03/2022]
Abstract
OBJECTIVE Children with intellectual disability and marked feeding difficulties may undergo gastrostomy insertion to assist with their nutritional and medication needs. Use has increased recently for younger children, and it is intended to provide long-term support. This study explored the perceived value of gastrostomy for the quality of life (QOL) of children with intellectual disabilities and their families. METHODS Twenty-one primary caregivers of children with intellectual disability aged 2-18 years participated in semistructured telephone interviews. Data were analysed using directed content analysis, and data were coded to existing QOL domains relevant to children with intellectual disability and their families. RESULTS Benefits in each of the child and family QOL domains were represented in the interview data. For children, the impacts of gastrostomy for the physical health domain were predominant, supplemented by experiences of value for emotional well-being, social interactions, leisure activities and independence. For families, gastrostomy was integrated into multiple aspects of QOL relating to family interactions, parenting, resources and supports, health and safety, and advocacy support for disability. Shortcomings related to difficulties with equipment and complications. CONCLUSIONS Our comprehensive overview of the value of gastrostomy for children with intellectual disability and their families was classified within a QOL framework. Gastrostomy was mainly supportive over long time periods across many QOL domains. Findings will be of use to patient counselling and education and the development of family support resources.
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Affiliation(s)
- Emma J Glasson
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Nedlands, Western Australia, Australia
| | - David Forbes
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - Madhur Ravikumara
- Department of Gastroenterology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Lakshmi Nagarajan
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Nedlands, Western Australia, Australia.,Children's Neuroscience Service, Department of Neurology, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Paediatrics, The University of Western Australia, Perth, Australia, Perth, Western Australia, Australia
| | - Andrew Wilson
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Nedlands, Western Australia, Australia.,School of Paediatrics, The University of Western Australia, Perth, Australia, Perth, Western Australia, Australia.,Department of Respiratory Medicine, Perth Children's Hospital, Perth, Western Australia, Australia.,School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - Peter Jacoby
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Nedlands, Western Australia, Australia
| | - Kingsley Wong
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Nedlands, Western Australia, Australia
| | - Helen Leonard
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Nedlands, Western Australia, Australia
| | - Jenny Downs
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Nedlands, Western Australia, Australia .,School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
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Wong K, Glasson EJ, Jacoby P, Srasuebkul P, Forbes D, Ravikumara M, Wilson A, Bourke J, Trollor J, Leonard H, Nagarajan L, Downs J. Survival of children and adolescents with intellectual disability following gastrostomy insertion. JOURNAL OF INTELLECTUAL DISABILITY RESEARCH : JIDR 2020; 64:497-511. [PMID: 32319159 DOI: 10.1111/jir.12729] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 01/17/2020] [Revised: 04/01/2020] [Accepted: 04/02/2020] [Indexed: 06/11/2023]
Abstract
BACKGROUND Positive health outcomes have been observed following gastrostomy insertion in children with intellectual disability, which is being increasingly used at younger ages to improve nutritional intake. This study investigated the effect of gastrostomy insertion on survival of children with severe intellectual disability. METHODS We used linked disability and health data of children and adolescents who were born in Western Australia between 1983 and 2009 to compare survival of individuals with severe intellectual disability by exposure to gastrostomy status. For those born in 2000-2009, we employed propensity score matching to adjust for confounding by indication. Effect of gastrostomy insertion on survival was compared by pertinent health and sociodemographic risk factors. RESULTS Compared with children born in the 1980s-1990s, probability of survival following first gastrostomy insertion for those born in 2000-2009 was higher (2 years: 94% vs. 83%). Mortality risk was higher in cases than that in their matched controls (hazard ratio 2.9, 95% confidence interval 1.1, 7.3). The relative risk of mortality (gastrostomy vs. non-gastrostomy) may have differed by sex, birthweight and time at first gastrostomy insertion. Respiratory conditions were a common immediate or underlying cause of death among all children, particularly among those undergoing gastrostomy insertion. CONCLUSIONS Whilst gastrostomy insertion was associated with lower survival rates than children without gastrostomy, survival improved with time, and gastrostomy afforded some protection for the more vulnerable groups, and earlier use appears beneficial to survival. Specific clinical data that may be used to prioritise the need for gastrostomy insertion may be responsible for the survival differences observed.
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Affiliation(s)
- K Wong
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
| | - E J Glasson
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
| | - P Jacoby
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
| | - P Srasuebkul
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW Sydney, Sydney, New South Wales, Australia
| | - D Forbes
- Medical School, The University of Western Australia, Perth, Western Australia, Australia
| | - M Ravikumara
- Department of Gastroenterology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - A Wilson
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
- Department of Respiratory Medicine, Perth Children's Hospital, Perth, Western Australia, Australia
- School of Paediatrics, The University of Western Australia, Perth, Western Australia, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
| | - J Bourke
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
| | - J Trollor
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW Sydney, Sydney, New South Wales, Australia
| | - H Leonard
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
| | - L Nagarajan
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
- Children's Neuroscience Service, Department of Neurology, Perth Children's Hospital, Perth, Western Australia, Australia
| | - J Downs
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, Perth, Western Australia, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Western Australia, Australia
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Risk of Hospitalizations Following Gastrostomy in Children with Intellectual Disability. J Pediatr 2020; 217:131-138.e10. [PMID: 31812294 DOI: 10.1016/j.jpeds.2019.10.020] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/14/2019] [Revised: 09/23/2019] [Accepted: 10/09/2019] [Indexed: 01/04/2023]
Abstract
OBJECTIVE To examine the frequency of hospital admissions before and after gastrostomy insertion in children with severe intellectual disability. STUDY DESIGN We conducted a retrospective cohort study using linked health administrative and disability data from Western Australia (WA) and New South Wales (NSW). Children born between 1983 and 2009 in WA and 2002 and 2010 in NSW who had a gastrostomy insertion performed (n = 673 [WA, n = 325; NSW, n = 348]) by the end of 2014 (WA) and 2015 (NSW) were included. Conditional Poisson regression models were used to evaluate the age-adjusted effect of gastrostomy insertion on acute hospitalizations for all-cause, acute lower respiratory tract infections (LRTI), and epilepsy admissions. RESULTS The incidence of all-cause hospitalizations declined at 5 years after procedure (WA cohort 1983-2009: incidence rate ratio, 0.70 [95% CI, 0.60-0.80]; WA and NSW cohort 2002-2010: incidence rate ratio, 0.63 [95% CI, 0.45-0.86]). Admissions for acute LRTI increased in the WA cohort and remained similar in the combined cohort. Admissions for epilepsy decreased 4 years after gastrostomy in the WA cohort and were generally lower in the combined cohort. Fundoplication seemed to decrease the relative incidence of acute LRTI admissions in the combined cohort. CONCLUSIONS Gastrostomy was associated with health benefits including reduced all-cause and epilepsy hospitalizations, but was not protective against acute LRTI. These decreases in hospitalizations may reflect improved delivery of nutrition and medications.
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Wong K, Leonard H, Pearson G, Glasson EJ, Forbes D, Ravikumara M, Jacoby P, Bourke J, Srasuebkul P, Trollor J, Wilson A, Nagarajan L, Downs J. Epidemiology of gastrostomy insertion for children and adolescents with intellectual disability. Eur J Pediatr 2019; 178:351-361. [PMID: 30554367 DOI: 10.1007/s00431-018-3304-x] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/12/2018] [Revised: 12/01/2018] [Accepted: 12/04/2018] [Indexed: 12/12/2022]
Abstract
The largest group of recipients of pediatric gastrostomy have neurological impairment with intellectual disability (ID). This study investigated trends in first gastrostomy insertion according to markers of disadvantage and ID etiology. Linked administrative and health data collected over a 32-year study period (1983-2014) for children with ID born between 1983 and 2009 in Western Australia were examined. The annual incidence rate change over calendar year was calculated for all children and according to socioeconomic status, geographical remoteness, and Aboriginality. The most likely causes of ID were identified using available diagnosis codes in the linked data set. Of 11,729 children with ID, 325 (2.8%) received a first gastrostomy within the study period. The incidence rate was highest in the 0-2 age group and there was an increasing incidence trend with calendar time for each age group under 6 years of age. This rate change was greatest in children from the lowest socioeconomic status quintile, who lived in regional/remote areas or who were Aboriginal. The two largest identified groups of ID were genetically caused syndromes (15.1%) and neonatal encephalopathy (14.8%).Conclusion: Gastrostomy is increasingly used in multiple neurological conditions associated with ID, with no apparent accessibility barriers in terms of socioeconomic status, remoteness, or Aboriginality. What is Known: • The use of gastrostomy insertion in pediatrics is increasing and the most common recipients during childhood have neurological impairment, most of whom also have intellectual disability (ID). What is New: • Nearly 3% of children with ID had gastrostomy insertion performed, with the highest incidence in children under 3 years of age. • Gastrostomy use across different social groups was equitable in the Australian setting.
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Affiliation(s)
- Kingsley Wong
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, Western Australia, 6872, Australia
| | - Helen Leonard
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, Western Australia, 6872, Australia
| | - Glenn Pearson
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, Western Australia, 6872, Australia
| | - Emma J Glasson
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, Western Australia, 6872, Australia
| | - David Forbes
- Medical School, The University of Western Australia, Perth, Australia
- Department of Health, Government of Western Australia, Perth, Australia
| | - Madhur Ravikumara
- Department of Gastroenterology, Perth Children's Hospital, Perth, Australia
| | - Peter Jacoby
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, Western Australia, 6872, Australia
| | - Jenny Bourke
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, Western Australia, 6872, Australia
| | - Preeyaporn Srasuebkul
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW Sydney, Sydney, Australia
| | - Julian Trollor
- Department of Developmental Disability Neuropsychiatry, School of Psychiatry, UNSW Sydney, Sydney, Australia
| | - Andrew Wilson
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, Western Australia, 6872, Australia
- Department of Respiratory Medicine, Perth Children's Hospital, Perth, Australia
- School of Paediatrics, The University of Western Australia, Perth, Australia
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia
| | - Lakshmi Nagarajan
- Children's Neuroscience Service, Department of Neurology, Perth Children's Hospital, Perth, Australia
| | - Jenny Downs
- Telethon Kids Institute, Centre for Child Health Research, The University of Western Australia, PO Box 855, West Perth, Western Australia, 6872, Australia.
- School of Physiotherapy and Exercise Science, Curtin University, Perth, Australia.
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