Does gastrostomy tube feeding in children with cerebral palsy increase the risk of respiratory morbidity?
Child; Female; Humans; Male; Longitudinal Studies; Parenteral Nutrition; adolescent; Preschool; Non-U.S. Gov't; Research Support; infant; Gastrostomy/adverse effects; Cerebral Palsy/therapy; Risk Assessment/methods; home; Lung Diseases/etiology
BACKGROUND: Children with severe neurological impairment may have significant oral motor dysfunction and are at increased risk of nutritional deficiencies, poor growth, and aspiration pneumonia. Gastrostomy tube feeding is increasingly being used for nutritional support in these children. AIM: To examine the occurrence of respiratory morbidity before and after gastrostomy feeding tube insertion in children with severe neurological disabilities. METHODS: This study was nested in a longitudinal, prospective, uncontrolled, multicentre cohort study designed to investigate the outcomes of gastrostomy tube feeding in 57 children with severe neurological disabilities. Parents completed a questionnaire prior to (visit 1) and 6 and 12 months (visits 2 and 3) following the gastrostomy, detailing number of chest infections requiring antibiotics and/or hospital admission. RESULTS: Mean number of chest infections requiring antibiotics was 1.8 on visit 1 and 0.9 on visit 3. Hospital admissions for chest infections fell significantly from 0.5 to 0.09. CONCLUSION: This study provides no evidence for an increase in respiratory morbidity following insertion of a feeding gastrostomy in children with cerebral palsy.
2006
Sullivan P; Morrice JS; Vernon-Roberts A; Grant H; Eltumi M; Thomas AG
Archives Of Disease In Childhood
2006
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/10.1136/adc.2005.084442" target="_blank" rel="noreferrer">10.1136/adc.2005.084442</a>
Gastrostomy feeding versus oral feeding alone for children with cerebral palsy
Child; Humans; adolescent; Preschool; infant; Cerebral Palsy/complications; Eating; Gastrostomy/adverse effects; Nutrition Disorders/etiology/prevention & control
BACKGROUND: Children with cerebral palsy (CP) can be significantly disabled in terms of their ability to suck, chew and swallow. This can lead to significant impairment in feeding ability and, eventually, to under-nutrition. It can also result in aspiration of food into the lungs. Feeding time may be considerably increased and, instead of being an enjoyable experience, mealtimes may be distressing for both the child and carer. Increasingly for children unable to maintain a normal nutritional state feeding by mouth, gastrostomy or jejunostomy tubes are being used to provide the digestive system with nutrients. A gastrostomy tube is a feeding tube inserted surgically through the abdominal wall directly into the stomach. A jejunostomy feeding tube is inserted into the jejunum, part of the small intestine, either directly or via a previous gastrostomy. Although gastrostomy or jejunostomy placement may greatly facilitate feeding of children with CP, many carers find it very difficult to accept this intervention emotionally. The treatment is also relatively costly. For all of these reasons, its effectiveness requires assessment. OBJECTIVES: To assess the effects of nutritional supplementation given via gastrostomy or jejunostomy in children with feeding difficulties due to cerebral palsy. SEARCH STRATEGY: We searched the Cochrane Library's register of controlled trials (CENTRAL) up to Issue 4, 2003, MEDLINE 1977 - December 2003, EMBASE 1980 - December 2003, CINAHL 1982 - December 2003, LILACS 1980 - end 2003, ASLIB 1983 - 2003 and Dissertation Abstracts 1980 - 2003. SELECTION CRITERIA: Only randomised controlled trials which compared delivery of nutrition via a gastrostomy or jejunostomy tube compared with oral feeding alone for children up to the age of 16 were considered for this review. DATA COLLECTION AND ANALYSIS: Selection of trials, data extraction and assessment of trial quality were undertaken independently by two reviewers. MAIN RESULTS: No trials were identified that met the inclusion criteria for this review. REVIEWERS' CONCLUSIONS: On the basis of this systematic review, considerable uncertainty about the effects of gastrostomy for children with cerebral palsy remains. A well designed and conducted randomised controlled trial should be undertaken to resolve the current uncertainties about medical management for children with cerebral palsy and physical difficulties in eating.
2004
Sleigh G; Sullivan P; Thomas AG
Cochrane Database Of Systematic Reviews
2004
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/10.1002/14651858.CD003943.pub2" target="_blank" rel="noreferrer">10.1002/14651858.CD003943.pub2</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>