Effectiveness of Fundoplication or Gastrojejunal Feeding in Children With Neurologic Impairment

Stone, Bryan L.; Hester, Gabrielle; Jackson, Daniel; Richardson, Troy; Hall, Matt; Gouripeddi, Ramkiran; Butcher, Ryan; Srivastava, Rajendu

doi:10.1542/hpeds.2016-0126

Cited by 36 publications

(25 citation statements)

References 42 publications

(40 reference statements)

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“…The disadvantages of GJ include the need for continuous feeding, retrograde dislodgement of the tube, tube obstruction and mechanical failure. In a report by Stone et al11 GJ and fundoplication in NI patients had similar reflux-related hospitalization outcomes within the first year.…”

Section: Discussionmentioning

confidence: 84%

The outcomes of fundoplication and gastrostomy in neurologically impaired children in a tertiary care hospital in Saudi Arabia

Al-Namshan

Alkharashi

Crankson

et al. 2019

SMJ

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Objectives: To evaluate the outcomes of fundoplication and gastrostomy (GT) in neurologically impaired (NI) children. Methods: A retrospective review of medical charts was performed on 178 NI children up to the age of 14 years inclusive, who underwent fundoplication and GT between 1999 and 2014. Results: After fundoplication, the incidence-rate (person-month) of all hospital admissions (0.95 versus 0.13; p <0.001), gastroesophageal reflux (GER) - related admissions (0.67 versus 0.09; p <0.001), and admissions for seizures (0.21 versus 0.01; p <0.001 were significantly decreased. Furthermore, all emergency department visits (0.94 versus 0.23; p <0.001), GER visits (0.61 versus 0.12; p <0.001), seizure visits (0.24 versus 0.01: p <0.001) were significantly reduced. The mortality rate after fundoplication was 35%. The risk factors for predicting mortality were being male (odds ratio: 2.2, p =0.027) and being a do not resuscitate (DNR) child (odds ratio: 5.2, p <0.001). Majority of the children that died within a year after the procedure were DNR. Conclusions: Fundoplication with GT is effective in reducing hospital admissions and emergency department visits from GER and seizures in NI children. Because of high mortality within a year of fundoplication with GT in DNR children, anti-reflux medications with GT might be an alternative.

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Section: Discussionmentioning

confidence: 84%

The outcomes of fundoplication and gastrostomy in neurologically impaired children in a tertiary care hospital in Saudi Arabia

Al-Namshan

Alkharashi

Crankson

et al. 2019

SMJ

View full text Add to dashboard Cite

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“…Also, Ontario does not have a specific procedure code for advancement of a GT into the jejunum, so our finding that 5.3% of children received subsequent antireflux surgery over 5 years is likely an underestimate. Additionally, our cohort had higher rates of primary antireflux procedures (43%; predominantly GJTs) compared with a recent American study (18%; predominantly fundoplication), 5 which is important for study generalizability. The data in Table 1 suggest that the frequency of antireflux procedures in Ontario has changed over time, which is worthy of evaluation in future studies.…”

Section: Figurementioning

confidence: 77%

Survival and Health Care Use After Feeding Tube Placement in Children With Neurologic Impairment

et al. 2019

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BACKGROUND AND OBJECTIVES: Children with neurologic impairment (NI) often undergo feeding tube placement for undernutrition or aspiration. We evaluated survival and acute health care use after tube placement in this population.METHODS: This is a population-based exposure-crossover study for which we use linked administrative data from Ontario, Canada. We identified children aged 13 months to 17 years with a diagnosis of NI undergoing primary gastrostomy or gastrojejunostomy tube placement between 1993 and 2015. We determined survival time from procedure until date of death or last clinical encounter and calculated mean weekly rates of unplanned hospital days overall and for reflux-related diagnoses, emergency department visits, and outpatient visits. Rate ratios were estimated from negative binomial generalized estimating equation models adjusting for time and age. RESULTS: Two-year survival after feeding tube placement was 87.4% (95% confidence interval [CI]: 85.2%-89.4%) and 5-year survival was 75.8% (95% CI: 72.8%-78.4%). The adjusted rate ratio comparing weekly rates of unplanned hospital days during the 2 years after versus before tube placement was 0.92 (95% CI: 0.57-1.48). Similarly, rates of refluxrelated hospital days, emergency department visits, and outpatient visits were unchanged. Unplanned hospital days were stable within subgroups, although rates across subgroups varied. CONCLUSIONS:Mortality is high among children with NI after feeding tube placement. However, the stability of health care use before and after the procedure suggests that the high mortality may reflect underlying fragility rather than increased risk from nonoral feeding. Further research to inform risk stratification and prognostic accuracy is needed. abstract

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“…If this fails, gastrojejunostomy tube extension can be tried. Fundoplication and gastrojejunal feeding have similar outcomes ( 67 , 68 ). Jejunal feeding must be continuous and can be dislodged, requiring radiological intervention for reinsertion.…”

Section: Risk Factors For Respiratory Illnessmentioning

confidence: 99%

Evaluation and Management of Respiratory Illness in Children With Cerebral Palsy

et al. 2020

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Cerebral palsy (CP) is the most common cause of disability in childhood. Respiratory illness is the most common cause of mortality, morbidity, and poor quality of life in the most severely affected children. Respiratory illness is caused by multiple and combined factors. This review describes these factors and discusses assessments and treatments. Oropharyngeal dysphagia causes pulmonary aspiration of food, drink, and saliva. Speech pathology assessments evaluate safety and adequacy of nutritional intake. Management is holistic and may include dental care, and interventions to improve nutritional intake, and ease, and efficiency of feeding. Behavioral, medical, and surgical approaches to drooling aim to reduce salivary aspiration. Gastrointestinal dysfunction, leading to aspiration from reflux, should be assessed objectively, and may be managed by lifestyle changes, medications, or surgical interventions. The motor disorder that defines cerebral palsy may impair fitness, breathing mechanics, effective coughing, and cause scoliosis in individuals with severe impairments; therefore, interventions should maximize physical, musculoskeletal functions. Airway clearance techniques help to clear secretions. Upper airway obstruction may be treated with medications and/or surgery. Malnutrition leads to poor general health and susceptibility to infection, and improved nutritional intake may improve not only respiratory health but also constipation, gastroesophageal reflux, and participation in activities. There is some evidence that children with CP carry pathogenic bacteria. Prophylactic antibiotics may be considered for children with recurrent exacerbations. Uncontrolled seizures place children with CP at risk of respiratory illness by increasing their risk of salivary aspiration; therefore optimal control of epilepsy may reduce respiratory illness. Respiratory illnesses in children with CP are sometimes diagnosed as asthma; a short trial of asthma medications may be considered, but should be discontinued if ineffective. Overall, management of respiratory illness in children with CP is complex and needs well-coordinated multidisciplinary teams who communicate clearly with families. Regular immunizations, including annual influenza vaccination, should be encouraged, as well as good oral hygiene. Treatments should aim to improve quality of life for children and families and reduce burden of care for carers.

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Effectiveness of Fundoplication or Gastrojejunal Feeding in Children With Neurologic Impairment

Abstract: In children with NI, GER, and dysphagia: fundoplication and GJ feeding have similar RRH outcomes. Either intervention can reduce future aspiration risk; the choice can reflect non-RRH-related complication risks, caregiver preference, and clinician recommendation.

Cited by 36 publications

References 42 publications

The outcomes of fundoplication and gastrostomy in neurologically impaired children in a tertiary care hospital in Saudi Arabia

The outcomes of fundoplication and gastrostomy in neurologically impaired children in a tertiary care hospital in Saudi Arabia

Survival and Health Care Use After Feeding Tube Placement in Children With Neurologic Impairment

Evaluation and Management of Respiratory Illness in Children With Cerebral Palsy

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