Objectives:The aims of the present study were to assess the efficacy of a tube weaning program, and to identify factors associated with success and failure. Methods: This was a retrospective cohort study including all pediatric patients on enteral nutrition (EN) for !6 months for whom at least 1 attempt of weaning was performed in a single tertiary referral center from 2012 to 2017, with a minimum follow-up of 6 months after EN discontinuation. Weaning program was individualized to each child. Weaning success was defined a priori. Factors associated with success were investigated using multivariate analysis. Results: Ninety-four patients were enrolled, in whom a total of 114 attempts of weaning were performed at a median age of 51 AE 40 months. Success was achieved in 80 attempts (success rate of 70%). One hundred three (92%) weaning attempts were performed at home with a follow-up in the outpatient clinic, mostly (74%) by a progressive (>1 month) reduction of tube feeding. Patients who required psychological support during weaning had more failures than patients who did not (odds ratio ¼ 5.7, 95% confidence interval [1.2-27.0], P ¼ 0.03). The presence of impaired oral feeding skills at the time of EN discontinuation was also predictive of failure (odds ratio ¼ 6.2, 95% confidence interval [0.05-0.5], P ¼ 0.005). Conclusions: Our progressive, mostly outpatient-based, patient-tailored program of weaning from EN is effective for tube-dependent children. Children who need psychological support during weaning and those who present impaired oral feeding skills represent a subgroup of at-risk patients for whom alternative weaning strategies may need to be considered.
Background No consensus currently exists on tube‐weaning practice worldwide. The aim of this study was to describe tube‐weaning practice (indications and modalities) of a panel of pediatric gastroenterologists involved in the management of prolonged enteral nutrition (EN). Methods A cross‐sectional survey of pediatric gastroenterologists involved in the management of children receiving prolonged (>3 months) EN who were likely to be weaned was conducted. A questionnaire containing 24 questions was disseminated to the French Speaking Group of Paediatric Gastroenterology, Hepatology, and Nutrition members. The association between weaning practice and the experience of respondents was investigated. Results In total, 311 professionals were approached, and 64 questionnaires were completed (response rate 21%). Nearly all respondents (n = 61, 95%) reported using individualized weaning programs. Weaning attempts were performed more frequently at home, and follow‐up was performed in the outpatient clinic (97%) by progressive EN volume reduction (83%). Inpatient weaning was performed by only 28% of participants. The choice of the setting was predominantly (59%) based on parental request. Management and follow‐up involved mainly the referring pediatric gastroenterologist and the dietitian. Fifty‐one (80%) of the respondents experienced ≥1 weaning failure. Conclusions This is one of only a few studies examining real‐life pediatric tube‐weaning practices. Considerable practice variation between centers was observed; some of the common practices included the setting of weaning (outpatient vs inpatient) and the eligibility criteria. Increasing knowledge about weaning modalities is the starting point for the design of consensual standardized programs.
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