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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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Hook JE, Delany DR, Buckley JR, Chowdhury SM, Kavarana MN, Costello JM. Outcomes of Gastrostomy and Tracheostomy in Infants Undergoing Truncus Arteriosus Repair: Database Study Using the Pediatric Health Information System. Pediatr Crit Care Med 2023; 24:e540-e546. [PMID: 37294140 DOI: 10.1097/pcc.0000000000003295] [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] [Indexed: 06/10/2023]
Abstract
OBJECTIVES We sought to determine the prevalence of and factors associated with gastrostomy tube placement and tracheostomy in infants undergoing truncus arteriosus repair, and associations between these procedures and outcome. DESIGN Retrospective cohort study. SETTING Pediatric Health Information System database. PATIENTS Infants less than 90 days old who underwent truncus arteriosus repair from 2004 to 2019. INTERVENTIONS None. MEASUREMENTS AND MAIN RESULTS Multivariable logistic regression models were used to identify factors associated with gastrostomy tube and tracheostomy placement and to identify associations between these procedures and hospital mortality and prolonged postoperative length of stay (LOS; > 30 d). Of 1,645 subjects, gastrostomy tube was performed in 196 (11.9%) and tracheostomy in 56 (3.4%). Factors independently associated with gastrostomy tube placement were DiGeorge syndrome, congenital airway anomaly, admission age less than or equal to 2 days, vocal cord paralysis, cardiac catheterization, infection, and failure to thrive. Factors independently associated with tracheostomy congenital airway anomaly, truncal valve surgery, and cardiac catheterization. Gastrostomy tube was independently associated with prolonged postoperative LOS (odds ratio [OR], 12.10; 95% CI, 7.37-19.86). Hospital mortality occurred in 17 of 56 patients (30.4%) who underwent tracheostomy versus 147 of 1,589 patients (9.3%) who did not ( p < 0.001), and median postoperative LOS was 148 days in patients who underwent tracheostomy versus 18 days in those who did not ( p < 0.001). Tracheostomy was independently associated with mortality (OR, 3.11; 95% CI, 1.43-6.77) and prolonged postoperative LOS (OR, 9.85; 95% CI, 2.16-44.80). CONCLUSIONS In infants undergoing truncus arteriosus repair, tracheostomy is associated with greater odds of mortality; while gastrostomy and tracheostomy are strongly associated with greater odds of prolonged postoperative LOS.
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Affiliation(s)
- Jessica E Hook
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina College of Medicine, Charleston, SC
| | - Dennis R Delany
- Department of Anesthesiology and Critical Care Medicine, Johns Hopkins University School of Medicine, Baltimore, MD
| | - Jason R Buckley
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina College of Medicine, Charleston, SC
| | - Shahryar M Chowdhury
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina College of Medicine, Charleston, SC
| | - Minoo N Kavarana
- Division of Pediatric Cardiothoracic Surgery, Department of Surgery, Medical University of South Carolina College of Medicine, Charleston, SC
| | - John M Costello
- Division of Pediatric Cardiology, Department of Pediatrics, Medical University of South Carolina College of Medicine, Charleston, SC
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Edwards S, Hyman PE, Mousa H, Bruce A, Cocjin J, Dean K, Fleming K, Romine RS, Davis AM. iKanEat: protocol for a randomized controlled trial of megestrol as a component of a pediatric tube weaning protocol. Trials 2021; 22:169. [PMID: 33640012 PMCID: PMC7913389 DOI: 10.1186/s13063-021-05131-w] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/06/2021] [Accepted: 02/13/2021] [Indexed: 11/10/2022] Open
Abstract
Background Although tube feeding routinely saves the lives of children who do not eat by mouth, chronic tube feeding can be a burden to patients, caregivers, and families. Very few randomized trials exist regarding the best methods for weaning children from their feeding tubes. Methods The current paper describes a randomized controlled trial of an empirically supported outpatient treatment protocol for moving children from tube to oral eating called iKanEat. Specifically, we describe the methods of randomized double-blind, placebo-controlled trial which includes a 4-week course of megestrol, the only medication used in the iKanEat protocol, to determine whether the addition of megestrol results in improved child outcomes. The primary and secondary aims are to assess the safety and efficacy of megestrol as part of the iKanEat protocol. The third aim is to provide critical information about the impact of the transition from tube to oral feeding on parent stress and parent and child quality of life. Discussion This trial will provide data regarding whether megestrol is a safe and effective component of the iKanEat tube weaning protocol, as well as important data on how the tube weaning process impacts parent stress and parent and child quality of life. Trial registration ClinicalTrials.gov NCT#03815019. Registered on January 17, 2019
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Affiliation(s)
- Sarah Edwards
- Pediatric Gastroenterology, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Paul E Hyman
- Pediatric Gastroenterology, New Orleans Children's Hospital, New Orleans, LA, USA
| | - Hayat Mousa
- Pediatric Gastroenterology, Hepatology and Nutrition, University of California San Diego/Rady Children's Hospital, San Diego, CA, USA
| | - Amanda Bruce
- Department of Pediatrics, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 4004, Kansas City, KS, 66160, USA.,Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA
| | - Jose Cocjin
- Pediatric Gastroenterology, Children's Mercy Kansas City, Kansas City, MO, USA
| | - Kelsey Dean
- Department of Pediatrics, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 4004, Kansas City, KS, 66160, USA.,Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA
| | - Kandace Fleming
- Life Span Institute, University of Kansas, Lawrence, KS, USA
| | | | - Ann M Davis
- Department of Pediatrics, University of Kansas Medical Center, 3901 Rainbow Boulevard, MS 4004, Kansas City, KS, 66160, USA. .,Center for Children's Healthy Lifestyles & Nutrition, Kansas City, MO, USA.
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Suluhan D, Yildiz D, Surer I, Fidanci Eren B, Balamtekin N. Effect of Gastrostomy Tube Feeding Education on Parents of Children with Gastrostomy. Nutr Clin Pract 2020; 36:1220-1229. [DOI: 10.1002/ncp.10586] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Affiliation(s)
- Derya Suluhan
- Gulhane Faculty of Nursing Department of Pediatric Nursing, University of Health Sciences Turkey Ankara Turkey
| | - Dilek Yildiz
- Gulhane Faculty of Nursing Department of Pediatric Nursing, University of Health Sciences Turkey Ankara Turkey
| | - Ilhami Surer
- Department of Pediatric Surgery Gulhane Research and Training Hospital Ankara Turkey
| | - Berna Fidanci Eren
- Gulhane Faculty of Nursing Department of Pediatric Nursing, University of Health Sciences Turkey Ankara Turkey
| | - Necati Balamtekin
- Department of Pediatric Gastroenterology Gulhane Research and Training Hospital Ankara Turkey
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Gastrostomy and Tracheostomy After Complete Repair of Tetralogy of Fallot in Children With 22q11.2 Deletion Syndrome. Pediatr Crit Care Med 2020; 21:e776-e781. [PMID: 32168301 DOI: 10.1097/pcc.0000000000002339] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/26/2022]
Abstract
OBJECTIVES Caring for a child with gastrostomy and/or tracheostomy can cause measurable parental stress. It is generally known that children with 22q11.2 deletion syndrome are at greater risk of requiring gastrostomy or tracheostomy after heart surgery, although the magnitude of that risk after complete repair of tetralogy of Fallot has not been described. We sought to determine the degree to which 22q11.2 deletion is associated with postoperative gastrostomy and/or tracheostomy after repair of tetralogy of Fallot. DESIGN Retrospective cohort study. SETTING Pediatric Health Information System. PATIENTS Children undergoing complete repair of tetralogy of Fallot (ventricular septal defect closure and relief of right ventricular outflow tract obstruction) from 2003 to 2016. Patients were excluded if they had pulmonary atresia, other congenital heart defects, and/or genetic diagnoses other than 22q11.2 deletion. MEASUREMENTS AND MAIN RESULTS Two groups were formed on the basis of 22q11.2 deletion status. Outcomes were postoperative tracheostomy and postoperative gastrostomy. Bivariate analysis and Kaplan-Meier analysis at 150 days postoperatively were performed. There were 4,800 patients, of which 317 (7%) had a code for 22q11.2 deletion. There were no significant differences between groups for age at surgery or sex. Patients with 22q11.2 deletion had significantly higher rates of gastrostomy (18% vs 5%; p < 0.001) and higher rates of tracheostomy (7% vs 1%; p < 0.001); there was no difference for mortality. Kaplan-Meier analyses also showed higher rates of gastrostomy (p = 0.024) and tracheostomy (p = 0.037). CONCLUSIONS The present study establishes rates of postoperative gastrostomy and tracheostomy in children with 22q11.2 deletion after complete repair of tetralogy of Fallot. These data are useful to clinicians for providing families with preoperative counseling.
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Cheng CF, Werner NE, Doutcheva N, Warner G, Barton HJ, Kelly MM, Ehlenbach ML, Wagner T, Finesilver S, Katz BJ, Nacht C, Coller RJ. Codesign and Usability Testing of a Mobile Application to Support Family-Delivered Enteral Tube Care. Hosp Pediatr 2020; 10:641-650. [PMID: 32616602 DOI: 10.1542/hpeds.2020-0076] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/24/2022]
Abstract
BACKGROUND Enteral tubes are prevalent among children with medical complexity (CMC), and complications can lead to costly health care use. Our objective was to design and test the usability of a mobile application (app) to support family-delivered enteral tube care. METHODS Human-centered design methods (affinity diagramming, persona development, and software development) were applied with family caregivers of CMC to develop a prototype. During 3 waves of usability testing with design refinement between waves, screen capture software collected user-app interactions and inductive content analysis of narrative feedback identified areas for design improvement. The National Aeronautics and Space Administration Task Load Index and the System Usability Scale quantified mental workload and ease of use. RESULTS Design participants identified core app functions, including displaying care routines, reminders, tracking inventory and health data, caregiver communication, and troubleshooting. Usability testing participants were 80% non-Hispanic white, 28% lived in rural settings, and 20% had not completed high school. Median years providing enteral care was 2 (range 1-14). Design iterations improved app function, simplification, and user experience. The mean System Usability Scale score was 76, indicating above-average usability. National Aeronautics and Space Administration Task Load Index revealed low mental demand, frustration, and effort. All 14 participants reported that they would recommend the app, and that the app would help with organization, communication, and caregiver transitions. CONCLUSIONS Using a human-centered codesign process, we created a highly usable mobile application to support enteral tube caregiving at home. Future work involves evaluating the feasibility of longitudinal use and effectiveness in improving self-efficacy and reduce device complications.
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Affiliation(s)
| | - Nicole E Werner
- Department of Industrial and Systems Engineering, and.,Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Gemma Warner
- Department of Pediatrics, School of Medicine and Public Health
| | | | - Michelle M Kelly
- Department of Pediatrics, School of Medicine and Public Health.,Center for Quality and Productivity Improvement, University of Wisconsin-Madison, Madison, Wisconsin
| | | | - Teresa Wagner
- American Family Children's Hospital, University of Wisconsin Health, Madison, Wisconsin; and
| | - Sara Finesilver
- Department of Pediatrics, School of Medicine and Public Health
| | | | - Carrie Nacht
- Department of Pediatrics, School of Medicine and Public Health
| | - Ryan J Coller
- Department of Pediatrics, School of Medicine and Public Health,
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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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Kvello M, Åvitsland TL, Knatten CK, Fyhn TJ, Malt U, Emblem R, Bjørnland K. Psychologic Distress and Anxiety in Mothers of Children With Gastroesophageal Reflux Undergoing Antireflux Surgery. J Pediatr Gastroenterol Nutr 2019; 68:818-823. [PMID: 31124989 DOI: 10.1097/mpg.0000000000002286] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/10/2022]
Abstract
OBJECTIVES Parents of children with a chronic illness are at risk for impaired psychosocial functioning. Gastroesophageal reflux disease (GERD) is such a disease, and no studies have investigated effects of antireflux surgery on parental psychological distress. The aims of this study were to assess psychological distress and state and trait anxiety in mothers of children with GERD, and to explore possible changes after antireflux surgery. METHODS Mothers of children referred for antireflux surgery were included in this prospective study. Standardized questionnaires were used to evaluate psychological distress and state and trait anxiety before and 12 months after antireflux surgery. RESULTS Of 87 eligible mothers of children with GERD, 62 (71%) agreed to participate. All children had objectively verified GERD by 24-hour pH-monitoring and/or upper gastrointestinal contrast study and unsatisfactory symptom relief of pharmacological treatment. Thirty-one (50%) mothers returned questionnaires postoperatively. Preoperatively, mothers of children undergoing antireflux surgery reported high levels of psychological distress and state anxiety, and 54% had scores indicating clinically significant psychological distress. None of the preoperative child characteristics were found to significantly influence maternal psychological distress or state anxiety. Twelve months postoperatively, both psychological distress and state anxiety were reduced. CONCLUSIONS Mothers of children undergoing antireflux surgery reported reduced levels of psychological distress and state anxiety 12 months after the operation.
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Affiliation(s)
- Morten Kvello
- Institute of Clinical Medicine, University of Oslo.,Department of Gastrointestinal and Pediatric Surgery
| | | | | | | | - Ulrik Malt
- Institute of Clinical Medicine, University of Oslo
| | - Ragnhild Emblem
- Institute of Clinical Medicine, University of Oslo.,Department of Gastrointestinal and Pediatric Surgery
| | - Kristin Bjørnland
- Institute of Clinical Medicine, University of Oslo.,Department of Gastrointestinal and Pediatric Surgery
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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: 7] [Impact Index Per Article: 1.4] [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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Characterisation of information Hospitals Provide Parents on Tube Feeding, Including Tube Weaning. J Pediatr Nurs 2019; 44:e91-e97. [PMID: 30503253 DOI: 10.1016/j.pedn.2018.11.008] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/21/2018] [Revised: 11/11/2018] [Accepted: 11/13/2018] [Indexed: 12/12/2022]
Abstract
PURPOSE The purpose of this study was to characterise the content of hospital parent guides related to pediatric tube feeding. DESIGN AND METHODS A naturalistic search strategy was used to retrieve parent guides produced by hospitals using Google. Guides were analysed and content identified as being associated with codes which were derived from previous research into the education of parents on tube feeding and the prevention and treatment of tube feeding dependency and tube weaning. RESULTS Of the 17 collected guides from Australia, New Zealand, the United Kingdom, the United States of America, and Canada, most (64.7%) were published between 2009 and 2016. The guides provided comprehensive information regarding the reasons for and types of tube feeding, details of multidisciplinary teams and the practical management of tube feeding. All guides covered common medical problems and trouble-shooting solutions. Yet there was infrequent coverage of goal setting, risks and prevention of oral aversion and tube feeding dependency, social and emotional management of tube feeding and tube exit planning including tube weaning. CONCLUSIONS A gap exists in the education of families regarding psychosocial implications of tube feeding, oral aversion and tube feeding dependency and prevention, and tube exit planning. PRACTICE IMPLICATIONS Improvements need to be implemented in the development of education materials for families of children who require tube feeding. Families need information on all aspects of tube feeding including practical, social, and emotional management as well as advice on tube exit planning including tube weaning.
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Novaes NF, Cunha ACB. Enfrentamento e Resiliência Familiar na Tomada de Decisão pela Gastrostomia Infantil. PSICOLOGIA: CIÊNCIA E PROFISSÃO 2019. [DOI: 10.1590/1982-3703003187678] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/22/2022] Open
Abstract
Resumo A indicação do procedimento de gastrostomia em uma criança reverbera em suas famílias como um momento de crise, com a ruptura do padrão de funcionamento familiar. A decisão pela gastrostomia infantil envolve crenças e valores familiares, além de aspectos psicológicos, como o enfrentamento e a resiliência familiar. O objetivo deste estudo foi investigar o enfrentamento e a resiliência familiar de cuidadores de crianças frente à tomada de decisão pela gastrostomia infantil. Quatro cuidadores principais de crianças com indicação para gastrostomia responderam ao Inventário COPE, para avaliar estratégias e estilos de enfrentamento, e a entrevista “Indicadores de Resiliência Familiar”, elaborada para esse estudo. O relato verbal dos cuidadores foi analisado com base nos indicadores de resiliência familiar proposto por Walsh, adotando-se a Análise de conteúdo de Bardin. Os indicadores de resiliência familiar encontrados foram a “Busca em extrair significado da adversidade” e a “Perspectiva positiva”, junto com um enfrentamento caracterizado por maior frequência de estratégias como “ Coping ativo”, “Planejamento”, “Reinterpretação positiva e crescimento”, e “Retorno para a religiosidade”. Esses achados sugerem que as famílias foram capazes de superar os desafios impostos pela gastrostomia infantil e enfrentar as adversidades de forma ativa e planejada, quando reinterpretaram sua experiência atribuindo significados positivos à situação. Concluímos que a tomada de decisão resiliente e positiva pauta-se na negociação dos valores familiares e o saber clínico da equipe de saúde. Destacamos o trabalho empático dos profissionais de saúde com os cuidadores, fortalecendo as potencialidades destes para a sobrevivência e superação dos desafios impostos pela gastrostomia.
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National and regional trends in gastrostomy in very low birth weight infants in the USA: 2000-2012. J Perinatol 2018; 38:1270-1276. [PMID: 29925865 PMCID: PMC6195828 DOI: 10.1038/s41372-018-0145-4] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 12/14/2017] [Revised: 04/17/2018] [Accepted: 04/23/2018] [Indexed: 11/08/2022]
Abstract
OBJECTIVE To determine rates of gastrostomy (GT) in very low birth weight (VLBW) infants. STUDY DESIGN Retrospective, cross-sectional analysis of the Kids' Inpatient Database for the years 2000, 2003, 2006, 2009 and 2012. We identified VLBW births and infants undergoing a GT, with and without fundoplication, using ICD-9-CM codes. RESULT National rates (per 1000 VLBW births) of GT increased from 11.5 GT (95% CI 10-13) in 2000 to 22.9 (95% CI 20-25) in 2012 (p < 0.001). Gastrostomy with and without fundoplication increased during the study period (p < 0.001 in both groups). VLBW survival also increased from 78.5% in 2000 to 81.1% in 2012 (p < 0.001). In all study years, the Northeast census region had the lowest GT rates, while the West had the highest rates in 4 of the 5 study years. CONCLUSION Between 2000 and 2012, the incidence of GT in VLBW infants doubled, associated with improvements in survival in this population.
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Taylor C, Zhang M, Foster J, Novak I, Badawi N. Caregivers' experiences of feeding children with cerebral palsy: a systematic review protocol of qualitative evidence. JBI DATABASE OF SYSTEMATIC REVIEWS AND IMPLEMENTATION REPORTS 2018; 16:589-593. [PMID: 29521856 DOI: 10.11124/jbisrir-2017-003521] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
REVIEW QUESTION/OBJECTIVE The overall objective of this systematic review is to identify, critically appraise and synthesize the literature regarding the feeding experiences of caregivers who care for children with cerebral palsy. The specific review question is: What are the experiences of caregivers feeding children with cerebral palsy?
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Affiliation(s)
- Christine Taylor
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
- The New South Wales Centre for Evidence Based Health Care: a Joanna Briggs Institute Centre of Excellence
| | - Melissa Zhang
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
- The New South Wales Centre for Evidence Based Health Care: a Joanna Briggs Institute Centre of Excellence
| | - Jann Foster
- School of Nursing and Midwifery, Western Sydney University, Sydney, Australia
- The New South Wales Centre for Evidence Based Health Care: a Joanna Briggs Institute Centre of Excellence
- Ingham Research Institute, Liverpool, Australia
- Discipline of Obstetrics, Gynaecology and Neonatology, Sydney Medical School/Sydney Nursing School, University of Sydney, Sydney, Australia
| | - Iona Novak
- Cerebral Palsy Alliance Research Institute, Sydney, Australia
| | - Nadia Badawi
- Grace Centre for Newborn Care, The Children's Hospital at Westmead, Sydney, Australia
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Kvello M, Åvitsland TL, Knatten CK, Pripp AH, Aabakken L, Emblem R, Bjørnland K. Trends in the use of gastrostomies at a tertiary paediatric referral centre. Scand J Gastroenterol 2016; 51:625-32. [PMID: 26679498 DOI: 10.3109/00365521.2015.1123288] [Citation(s) in RCA: 8] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 02/04/2023]
Abstract
OBJECTIVES The aims of this study were to describe the population of paediatric patients undergoing gastrostomy placement at a Norwegian tertiary referral centre and to investigate trends over time in patient characteristics and operative technique. MATERIALS AND METHODS Patients <15 years of age getting a primary gastrostomy from 1994 to 2012 were included in this retrospective observational study. Patient data were collected from medical records and the National Registry. RESULTS Six-hundred forty-nine patients with a median age of 1.2 years [gestational week 30-14.9 years] were included. Neurological disorders (ND) was the most common underlying group of diagnosis (n = 311, 48%), followed by cardiac disease 104 (16%), congenital anomalies 85 (13%), respiratory disease 43 (7%), malignancy 29 (5%), and others 77 (12%). At follow-up, 162 (25%) patients were dead. A percutaneous endoscopic technique (PEG) was used in 401 (62%) patients, open surgery (OPEN) in 201 (31%) and laparoscopy (LAP) in 47 (7%). The number of gastrostomies per year more than doubled during the period (p < 0.001). More patients with cardiac disease and congenital anomalies were given a gastrostomy during the last years (all p < 0.05), whereas the number of patients with ND remained stable. Furthermore, there has been a decrease in median age and an increase in the number of PEG and LAP (p < 0.05). CONCLUSION The number of gastrostomy insertions has increased from 1994 to 2012. NDs is the most common underlying diagnosis in patients receiving a gastrostomy, PEG is the most common technique and patient characteristics have changed during the study period.
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Affiliation(s)
- Morten Kvello
- a Institute of Clinical Medicine, University of Oslo , Oslo , Norway ;,b Department of Gastrointestinal and Paediatric Surgery , Oslo University Hospital, Rikshospitalet , Norway
| | - Tone Lise Åvitsland
- a Institute of Clinical Medicine, University of Oslo , Oslo , Norway ;,b Department of Gastrointestinal and Paediatric Surgery , Oslo University Hospital, Rikshospitalet , Norway
| | - Charlotte Kristensen Knatten
- a Institute of Clinical Medicine, University of Oslo , Oslo , Norway ;,b Department of Gastrointestinal and Paediatric Surgery , Oslo University Hospital, Rikshospitalet , Norway
| | - Are Hugo Pripp
- c Oslo Centre of Biostatistics and Epidemiology, Oslo University Hospital , Oslo , Norway
| | - Lars Aabakken
- a Institute of Clinical Medicine, University of Oslo , Oslo , Norway ;,d Department of Gastroenterology , Oslo University Hospital, Rikshospitalet , Norway
| | - Ragnhild Emblem
- a Institute of Clinical Medicine, University of Oslo , Oslo , Norway ;,b Department of Gastrointestinal and Paediatric Surgery , Oslo University Hospital, Rikshospitalet , Norway
| | - Kristin Bjørnland
- a Institute of Clinical Medicine, University of Oslo , Oslo , Norway ;,b Department of Gastrointestinal and Paediatric Surgery , Oslo University Hospital, Rikshospitalet , Norway
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Edwards S, Davis AM, Bruce A, Mousa H, Lyman B, Cocjin J, Dean K, Ernst L, Almadhoun O, Hyman P. Caring for Tube-Fed Children. JPEN J Parenter Enteral Nutr 2015; 40:616-22. [PMID: 25791833 DOI: 10.1177/0148607115577449] [Citation(s) in RCA: 54] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/19/2014] [Accepted: 02/10/2015] [Indexed: 11/15/2022]
Affiliation(s)
- Sarah Edwards
- Children’s Mercy Hospital and Clinics, Kansas City, MO
| | - Ann M. Davis
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas
- Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, Missouri
| | - Amanda Bruce
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas
- Center for Children’s Healthy Lifestyles & Nutrition, Kansas City, Missouri
| | | | - Beth Lyman
- Children’s Mercy Hospital and Clinics, Kansas City, MO
| | - Jose Cocjin
- Children’s Mercy Hospital and Clinics, Kansas City, MO
| | - Kelsey Dean
- Children’s Mercy Hospital and Clinics, Kansas City, MO
| | - Linda Ernst
- Children’s Mercy Hospital and Clinics, Kansas City, MO
| | - Osama Almadhoun
- Department of Pediatrics, University of Kansas Medical Center, Kansas City, Kansas
| | - Paul Hyman
- New Orleans Children’s Hospital, New Orleans, Louisiana
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Merras-Salmio L, Aronen ET, Kuitunen M, Pelkonen AS, Mäkelä MJ, Kolho KL. How mothers perceive infants with unspecific gastrointestinal symptoms suggestive of cow's milk allergy? Acta Paediatr 2014; 103:524-8. [PMID: 24812712 DOI: 10.1111/apa.12577] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
AIM To determine whether specific infant behavioural characteristics are present in children suspected of cow's milk allergy because of gastrointestinal symptoms. METHODS We prospectively recruited 57 children (median age 8.7 months) with a suspicion of gastrointestinally manifested cow's milk protein allergy (GI-CMPA). None had detectable cow's milk-specific IgE. Mothers were asked to complete the Parenting Stress Index (PSI) Child Domain, and those with children below 18 months of age (n = 49) also the Infant Temperament Questionnaire (ITQ). GI-CMPA was diagnosed with the double-blind, placebo-controlled food challenge. Control group (n = 22) consisted of patients (age range 4-26 months), attending the Pediatric Allergy Unit, who did not have diagnosed or suspected food allergies. RESULTS The scores were significantly higher for the PSI (n = 48) Child Domain (p < 0.0001) and for the ITQ (n = 44) subscale Difficultness (p = 0.0045) compared with the control patients without suspected/diagnosed food allergy. The difference between the challenge positive (n = 18) and negative (n = 39) patients remained statistically insignificant. After 6 months, in both groups, the scores (PSI Child Domain p = 0.0004, ITQ Difficultness p = 0.0393) were lower, but the ITQ Difficultness score still remained higher than in the controls (p = 0.0453). CONCLUSION The mothers often perceive infants with unspecific symptoms suggestive of GI-CMPA as demanding and temperamentally difficult.
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Affiliation(s)
- Laura Merras-Salmio
- Division of Pediatric Gastroenterology; Children's Hospital; Helsinki University Central Hospital; Helsinki Finland
| | - Eeva T. Aronen
- Department of Child Psychiatry; Children's Hospital; Helsinki University and Helsinki University Central Hospital; Helsinki Finland
| | - Mikael Kuitunen
- Children's Hospital; Helsinki University Central Hospital; Helsinki Finland
| | - Anna S. Pelkonen
- Department of Pediatric Allergology; Helsinki University Central Hospital; Helsinki Finland
| | - Mika J. Mäkelä
- Department of Pediatric Allergology; Helsinki University Central Hospital; Helsinki Finland
| | - Kaija-Leena Kolho
- Division of Pediatric Gastroenterology; Children's Hospital; Helsinki University Central Hospital; Helsinki Finland
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Fabre A, Baumstarck K, Cano A, Loundou A, Berbis J, Chabrol B, Auquier P. Assessment of quality of life of the children and parents affected by inborn errors of metabolism with restricted diet: preliminary results of a cross-sectional study. Health Qual Life Outcomes 2013; 11:158. [PMID: 24050652 PMCID: PMC3848736 DOI: 10.1186/1477-7525-11-158] [Citation(s) in RCA: 34] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/04/2013] [Accepted: 09/11/2013] [Indexed: 01/07/2023] Open
Abstract
Introduction The development in therapeutic strategies has increased survival of children affected by inborn errors of metabolism with restricted diet (IEMRD). These diseases have mild- and long-term consequences on the health. Little is known about the impact on the quality of life (QoL) of children and their families. The aims of this study were: to compare the QoL of the children and parents affected by IEMRD with the QoL of the general population and one pathology associated with long-term consequences. Patients and methods This cross-sectional study was performed at the French Reference Center for inborn metabolic disorders (Marseille, France). Inclusion criteria were: a child with a diagnosis of organic aciduria, urea cycle defect, or maple syrups urine disease (MSUD). Socio-demographics, clinical data, and QoL were recorded. Results Twenty-one of 32 eligible families were included during a planned routine visit. Ten (47%, 95% CI 27-69%) children were affected by organic aciduria, six (29%, 95% CI 10-48%) by urea cycle defects, and five (24%, 95% CI 6-42%) by MSUD. Among the younger children, the general well-being was significantly lower in the children with IEMRD than in the leukemia children (58 ± 16 versus 76 ± 15, p = 0.012), and among the older children, the leisure activities were significantly lower in the children with IEMRD than in the leukemia children (29 ± 18 versus 62 ± 22, p < 10-3), while the relationships with teachers were better (76 ± 23 versus 60 ± 23, p = 0.01). The physical QoL score was lower in the parents than in the French norms (66 ± 21 versus 75 ± 1, p = 0.05). Factors modulating QoL were: eating and neurologic disorders, enteral nutrition, and feeding modalities. Conclusion The children and the parents of children affected presented altered ‘physical’ and ‘social’ QoL scores compared with the norms and patients with leukemia and their families. Future studies based on larger cohort studies should determine the different weights of potential predictive factors of QoL.
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Affiliation(s)
- Alexandre Fabre
- EA3279, Self-perceived Health Assessment Research Unit, School of Medicine, Université de la Méditerranée, 27 bd Jean Moulin, Marseille 13385, France.
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