Gastrostomy tube feeding in children with cerebral palsy: a prospective, longitudinal study
Child; Female; Humans; infant; Male; Treatment Outcome; Longitudinal Studies; Time Factors; Demography; adolescent; Preschool; infant; Newborn; retrospective studies; Enteral Nutrition/methods; Anthropometry/methods; Body Height/physiology; Cerebral Palsy/classification/nursing/surgery; Child Development/physiology; Gastrostomy/methods; Head/growth & development; Nutritional Status/physiology; Weight Gain/physiology
We report a longitudinal, prospective, multicentre cohort study designed to measure the outcomes of gastrostomy tube feeding in children with cerebral palsy (CP). Fifty-seven children with CP (28 females, 29 males; median age 4y 4mo, range 5mo to 17y 3mo) were assessed before gastrostomy placement, and at 6 and 12 months afterwards. Three-quarters of the children enrolled (43 of 57) had spastic quadriplegia; other diagnoses included mixed CP (6 of 57), hemiplegia (3 of 57), undiagnosed severe neurological impairment (3 of 57), ataxia (1 of 57), and extrapyramidal disorder (1 of 57). Only 7 of 57 (12%) could sit independently, and only 3 of 57 (5%) could walk unaided. Outcome measures included growth/anthropometry, nutritional intake, general health, and complications of gastrostomy feeding. At baseline, half of the children were more than 38D below the average weight for their age and sex when compared with the standards for typically-developing children. Weight increased substantially over the study period; the median weight z score increased from -3 before gastrostomy placement to -2.2 at 6 months and -1.6 at 12 months. Almost all parents reported a significant improvement in their child's health after this intervention and a significant reduction in time spent feeding. Statistically significant and clinically important increases in weight gain and subcutaneous fat deposition were noted. Serious complications were rare, with no evidence of an increase in respiratory complications.
2005
Sullivan P; Juszczak E; Bachlet AM; Lambert B; Vernon-Roberts A; Grant HW; Eltumi M; McLean L; Alder N; Thomas AG
Developmental Medicine And Child Neurology
2005
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1111/j.1469-8749.2005.tb01095.x" target="_blank" rel="noreferrer">10.1111/j.1469-8749.2005.tb01095.x</a>
Quantitative and qualitative analysis of gastroesophageal reflux after percutaneous endoscopic gastrostomy
Child; Female; Humans; Male; Hydrogen-Ion Concentration; Acute Disease; quality of life; Preschool; Enteral Nutrition/methods; Weight Gain; Monitoring; Endoscopy; Airway Obstruction/diagnosis; Gastroesophageal Reflux/epidemiology/etiology/therapy; Gastrointestinal/adverse effects/methods; Gastrostomy/adverse effects/methods; Nervous System Diseases/rehabilitation; Physiologic/methods/statistics & numerical data; Postoperative Complications/diagnosis/epidemiology/etiology; Vomiting/diagnosis
BACKGROUND/PURPOSE: Percutaneous endoscopic gastrostomy (PEG) is of great benefit to a defined population of children, but gastrostomy has been implicated in causation or exacerbation of gastroesophageal reflux (GER). The aim of this study was to quantitatively and qualitatively analyze the effect of PEG on GER. METHODS AND MATERIAL: Sixty-four children mean age 6.7 +/- 4.2 years, most of whom were impaired neurologically were evaluated for GER after PEG between 1998 and 2000. Twenty-four-hour pH monitoring was used for quantitative assessment. Qualitative analysis was by interview to record the following: vomiting, choking, chest infection, and weight gain. RESULTS: Twenty-four hour pH monitoring was performed 9.4 +/- 1.2 weeks after PEG. Patients underwent follow-up for 18 +/- 6 months. Seventy-two percent who did not have reflux before PEG remained reflux free. Fourteen percent who had GER before PEG continued to have reflux (P .05). Six percent of patients with preexisting GER improved post-PEG. Of the 14 patients (22%) who had or continued to have reflux after PEG, 11 of 14 (79%) underwent antireflux surgery, and 21% were managed successfully by intensive medical treatment and change of feeding regimen. Only 6% experienced difficulties and complications with the device. Forty-eight percent of patients did not vomit pre- or postoperation. In 16%, vomiting improved post-PEG, whereas 14% experienced minor deterioration (1 to 2 vomits per month). Major deterioration was experienced by 22%. Weight gain occurred in 77%, and in 23% there was no loss of weight. There was an overall improvement in quality of life in 88% after PEG. Overall improvement in quality of life post-PEG, post-antireflux surgery and post-intensive medical management for pathologic GER was 94%. CONCLUSIONS: (1) PEG did not precipitate or exacerbate GER quantitatively or qualitatively in the majority of children. (2) A normal 24-hour pH study predicted a favourable outcome after PEG. (3) An abnormal preoperation pH study predicted persistence or worsening reflux after PEG, but not all of these patients required an antireflux procedure. (4) GER is not a contraindication to PEG, the overall benefits of which outweigh the risks.
2002
Samuel M; Holmes K
Journal Of Pediatric Surgery
2002
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Journal Article
<a href="http://doi.org/10.1053/jpsu.2002.30267" target="_blank" rel="noreferrer">10.1053/jpsu.2002.30267</a>
Feeding jejunostomy in patients with neurologic disorders
Female; Humans; Male; Adult; Prognosis; Aged; Middle Aged; Risk; adolescent; retrospective studies; Anesthesia; Deglutition Disorders/etiology/therapy; Enteral Nutrition/methods; General/adverse effects; Jejunum/surgery; methods; Nervous System Diseases/complications; Postoperative Complications/mortality
A retrospective study of 54 patients who underwent feeding jejunostomy because of dysphagia on a neurologic basis was performed to determine risk factors affecting a postoperative mortality of 33% and six-month mortality of 67%. Advanced patient age, depressed preoperative level of consciousness, general anesthesia, and the technique of Witzel's jejunostomy were associated with increased postoperative level of consciousness carried an especially poor six month prognosis. It is concluded that a Roux-en-Y jejunostomy should be considered in patients with a hopelessly irreversible neurologic deficit. In all other situations, Stamm's jejunostomy is the feeding procedure of choice.
1981
Matino JJ
Archives Of Surgery (chicago, Ill. : 1960)
1981
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1001/archsurg.1981.01380140023005" target="_blank" rel="noreferrer">10.1001/archsurg.1981.01380140023005</a>
Functional duodenal obstruction (superior mesenteric artery or cast syndrome) in cerebral palsy
Child; Female; Humans; Enteral Nutrition/methods; Cerebral Palsy/complications; Duodenal Obstruction/complications/physiopathology; Nutrition Disorders/diet therapy/etiology
An 8-yr-old girl with cerebral palsy who was chronically malnourished presented with functional duodenal obstruction (superior mesenteric artery or cast syndrome) proven by barium meal. Six months of feeding through a fluoroscopically positioned gastrojejunal tube generated sufficient weight gain and increase in body bulk to cure the functional obstruction.
1989
Vaisman N; Stringer DA; Pencharz P
Journal Of Parenteral And Enteral Nutrition
1989
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Journal Article
<a href="http://doi.org/10.1177/0148607189013003326" target="_blank" rel="noreferrer">10.1177/0148607189013003326</a>
Gastrointestinal problems in the neurologically impaired child
Child; Humans; Preschool; Q3 Literature Search; Enteral Nutrition/methods; Cerebral Palsy/complications; Gastrostomy/adverse effects; Constipation/etiology; Gastroesophageal Reflux/etiology/physiopathology/surgery; Gastrointestinal Diseases/etiology/physiopathology; Gastrointestinal Motility; Nervous System Diseases/complications/physiopathology; Nutrition Physiology
Damage to the developing central nervous system may result in significant dysfunction in the gastrointestinal tract and is reflected in impairment in oral-motor function, rumination, gastro-oesophageal reflux, with or without aspiration, delayed gastric emptying and constipation. These problems can all potentially contribute to feeding difficulty in disabled children. Early recognition of an infant with neurological impairment that is compromising the normal feeding process is crucial. Detailed assessment of the nature of the feeding difficulties will help to predict the anticipated future nutritional needs and will allow decisions to be made about the appropriateness of input from different professionals (speech therapy, dietitians, gastroenterologists). Only when such information has been carefully assembled will rational and directed medical and surgical therapy be possible. Nutritional rehabilitation of disabled children can be associated with increased mortality and morbidity secondary to gastro-oesophageal reflux, retching, dumping syndrome or aspiration. It may also entail an increased work for care givers and increase costs of care. It is therefore necessary to document the impact of such rehabilitation on growth and quality of life for both patient and care giver.
1997
Sullivan P
Bailliere's Clinical Gastroenterology
1997
Article information provided for research and reference use only. PedPalASCNET does not hold any rights over the resource listed here. All rights are retained by the journal listed under publisher and/or the creator(s).
Journal Article
<a href="http://doi.org/10.1016/s0950-3528(97)90030-0" target="_blank" rel="noreferrer">10.1016/s0950-3528(97)90030-0</a>
Tube feeding in palliative care: benefits and problems
Female; Humans; Aged; Gastrostomy; Nutritional Requirements; Enteral Nutrition/methods; Palliative Care/methods; Nutrition Assessment; Terminal Care/methods; Weight Loss/physiology; Energy Intake/physiology; Laryngeal Neoplasms/physiopathology/radiotherapy
Percutaneous endoscopic gastrostomy techniques are becoming more widely available and will be considered increasingly for patients with head and neck or upper gastrointestinal malignancies, and for neurological dysphagia, as occurs in motor neurone disease. This case history illustrates some of the practical and ethical issues raised by their use.
1994
Boyd KJ; Beeken L
Palliative Medicine
1994
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Journal Article
<a href="http://doi.org/10.1177/026921639400800210" target="_blank" rel="noreferrer">10.1177/026921639400800210</a>