Gastrostomy Tube Feeding in Children With Developmental or Acquired Disorders: A Longitudinal Comparison on Healthcare Provision and Eating Outcomes 4 Years After Gastrostomy

Backman, Ellen; Karlsson, Ann‐Kristin; Sjögreen, Lotta

doi:10.1002/ncp.10056

Cited by 8 publications

(8 citation statements)

References 29 publications

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“…Patients' primary diagnoses are reported in the NPR using International Classification of Diseases, 10th Revision (ICD-10) codes. 17 Using a categorization established previously, 6,18 the primary diagnoses of children were sorted by the authors as being either 'developmental', for example, neurodevelopmental disabilities or congenital malformations, or 'acquired', that is, relating to conditions contracted after birth (Table S1, online supporting information). In some cases, several diagnostic codes were available, which gave a detailed picture of a child's health and any associated disorders.…”

Section: Study Variablesmentioning

confidence: 99%

“…As suggested by Cass, 5 we need to move beyond the overall outcomes of gastrostomy tube insertion to nuance our understanding of alternative feeding methods. In a study exploring the use of gastrostomy tube feeding in 51 children with developmental and acquired disorders, Backman et al 6 found major differences regarding age at gastrostomy tube insertion and eating outcomes after 4 years between the two study groups. Children with developmental disorders (e.g.…”

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confidence: 99%

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Gastrostomy tube insertion in children with developmental or acquired disorders: a register‐based study

Backman

Sjögreen

2020

Develop Med Child Neuro

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Aim To describe trends in gastrostomy tube insertion in children with developmental or acquired disorders in Sweden and assess their demographic characteristics. Method Children aged 0 to 18 years with gastrostomy tube insertions recorded between 1998 and 2014 were identified in the Swedish National Patient Register. Associations between disorder type and year of surgery, as well as age at surgery, were analysed using linear regression analyses. The association between disorder type and mortality 2 years from gastrostomy tube insertion was also analysed using logistic regression analysis. Results The data for 4112 children (2182 males, 1930 females), with a median age of 2 years (interquartile range=1–8y), were analysed. Children who presented with developmental disorders were the largest group (n=3501, 85%). The most common diagnosis in children with developmental disorders was cerebral palsy (n=165, 4%). In children with acquired disorders, acute lymphoblastic leukaemia (n=117, 3%) was the most common diagnosis. Gastrostomy tube insertions increased from 1998 to 2014, with the greatest increase in children with developmental disorders, who were younger than children with acquired disorders when the gastrostomy tube was first inserted. Age at tube insertion decreased in both groups during the study period. Mortality was higher in children with acquired disorders, suggesting that gastrostomy tube insertion should be part of a palliative care approach. Interpretation Child characteristics differed depending on whether the underlying disorder was developmental or acquired, suggesting a need for clinical health care guidelines related to the specific goals of gastrostomy tube insertion. What this paper adds Gastrostomy tube insertions increased by 140% from 1998 to 2014 in Sweden. The age of children with developmental disorders decreased by 1 month per year during the study period. Children presenting with developmental disorders were younger than children with acquired disorders when the gastrostomy tube was first inserted. Mortality was higher in children with acquired disorders.

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Section: Study Variablesmentioning

confidence: 99%

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confidence: 99%

Gastrostomy tube insertion in children with developmental or acquired disorders: a register‐based study

Backman

Sjögreen

2020

Develop Med Child Neuro

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“…These time horizons were selected because of the time frame for the dependency of G-tube treatment. 24–27…”

Section: Methodsmentioning

confidence: 99%

An Economic Analysis of Intensive Multidisciplinary Interventions for Treating Medicaid-Insured Children with Pediatric Feeding Disorders

et al. 2020

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Background. Intensive multidisciplinary intervention (IMI) represents a well-established treatment for pediatric feeding disorders (PFDs), but program availability represents an access care barrier. We develop an economic analysis of IMI for weaning from gastronomy tube (G-tube) treatment for children diagnosed with PFDs from the Medicaid programs’ perspective, where Medicaid programs refer to both fee-for-service and managed care programs. Methods. The 2010–2012 Medicaid Analytic eXtract claims provided health care data for children aged 13 to 72 months. An IMI program provided data on average admission costs. We employed a finite-horizon Markov model to simulate PFD treatment progression assuming 2 treatment arms: G-tube only v. IMI targeting G-tube weaning. We compared the expenditure differential between the 2 arms under varying time horizons and treatment effectiveness. Results. Overall Medicaid expenditure per member per month was $6814, $2846, and $1550 for the study population of children with PFDs and G-tube treatment, the control population with PFDs without G-tube treatment, and the no-PFD control population, respectively. The PFD-diagnosed children with G-tube treatment only had the highest overall expenditures across all health care settings except psychological services. The expenditure at the end of the 8-year time horizon was $405,525 and $208,218 per child for the G-tube treatment only and IMI arms, respectively. Median Medicaid expenditure was between 1.7 and 2.2 times higher for the G-tube treatment arm than for the IMI treatment arm. Limitations. Data quality issues could cause overestimates or underestimates of Medicaid expenditure. Conclusions. This study demonstrated the economic benefits of IMI to treat complex PFDs from the perspective of Medicaid programs, indicating this model of care not only holds benefit in terms of improving overall quality of life but also brings significant expenditure savings in the short and long term.

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“…Although the provision of basic nutrition is often in focus, the use of a G-tube also effects feeding, eating and the more culturally charged mealtime, thus covering the biological, psychological and social dimensions of human functioning [2,4]. Previous studies have shown the need for nutrition via a G-tube lasting several years for children with developmental disorders, for example, congenital neurological or chromosomal abnormalities [5,6]. This means that everyday mealtime activities will be deeply affected for a considerable period of time for such children.…”

Section: Introductionmentioning

confidence: 99%

“…Correspondingly, it has been advised that communicative, social and emotional aspects, as well as strategies enabling participation in everyday life, are incorporated into clinical practice, to improve families' mealtimes and increase the overall success of G-tubes [15,19]. Despite the recommendations to address biological, psychological and social aspects in the health care of children using G-tubes, previous research describes a lack of professional guidance to families in adapting to everyday life with a G-tube and a predominant focus on nursing, supporting nutrition, adequate growth and monitoring safe swallowing [5,13,[20][21][22]. Caregivers have expressed frustration towards health professionals as "being removed from the realities of what is going on in the home" [14] (Russel et al 2017, p.7).…”

Section: Introductionmentioning

confidence: 99%

Documentation of everyday life and health care following gastrostomy tube placement in children: a content analysis of medical records.

Backman

Granlund

Karlsson

2019

Disability and Rehabilitation

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Background: Everyday routines play a vital role in child functioning and development. This study explored health professionals' documentation of everyday life and health care during the first year following gastrostomy tube placement in children and the content of intervention goals. Methods: The medical records of 39 children (median age 38 months, min-max: 15-192) in one region of Sweden were analysed. A content analysis approach was used with an inductive qualitative analysis supplemented by a deductive, quantitative analysis of documented intervention goals following the ICF-CY. Results: One overall theme, "Seeking a balance", captured the view of life with a gastrostomy and the health care provided. Two categories, "Striving for physical health" and "Depicting everyday life" with seven sub-categories, captured the key aspects of the documentation. Twenty-one children (54%) had intervention goals related to the gastrostomy, and these goals primarily focused on the ICF-CY component "Body functions". Conclusions: To some extent the medical records reflected different dimensions of everyday life, but the intervention goals clearly focused on bodily aspects. Understanding how health care for children using a gastrostomy is documented and planned by applying an ecocultural framework adds a valuable perspective and can contribute to family-centred interventions for children using a gastrostomy. ä IMPLICATIONS FOR REHABILITATION There is a need for increased awareness in healthcare professionals for a more consistent and holistic healthcare approach in the management of children with gastrostomy tube feeding. This study suggests that an expanded focus on children's participation in everyday mealtimes and in the healthcare follow-up of gastrostomy tube feeding is important in enhancing the intervention outcome. Multidisciplinary teams with a shared bio-psycho-social understanding of health would contribute to a situation in which the everyday lives of households adapt to living with gastrostomy. Routine care for children with gastrostomy should follow a checklist combining crucial physiological aspects of gastrostomy tube feeding with seemingly mundane family functions in order to achieve a successful gastrostomy tube feeding intervention.

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Gastrostomy Tube Feeding in Children With Developmental or Acquired Disorders: A Longitudinal Comparison on Healthcare Provision and Eating Outcomes 4 Years After Gastrostomy

Cited by 8 publications

References 29 publications

Gastrostomy tube insertion in children with developmental or acquired disorders: a register‐based study

Gastrostomy tube insertion in children with developmental or acquired disorders: a register‐based study

An Economic Analysis of Intensive Multidisciplinary Interventions for Treating Medicaid-Insured Children with Pediatric Feeding Disorders

Documentation of everyday life and health care following gastrostomy tube placement in children: a content analysis of medical records.

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