Impact of Fundoplication Versus Gastrojejunal Feeding Tubes on Mortality and in Preventing Aspiration Pneumonia in Young Children With Neurologic Impairment Who Have Gastroesophageal Reflux Disease

Srivastava, Rajendu; Downey, Earl C.; O’Gorman, Molly; Feola, Peter; Samore, Matthew H.; Holubkov, Richard; Mundorff, Michael B.; James, Brent C.; Rosenbaum, Peter; Young, Paul C.; Dean, Jonathan

doi:10.1542/peds.2007-1740

Cited by 108 publications

(73 citation statements)

References 31 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Examples include comparative effectiveness of treatments for particular subgroups of children (eg, gastroesophageal reflux disease and comparative antireflux procedures for children with neurologic impairment). 67,68 It is unfortunate that CMC are often excluded from conditionspecific studies because of the rarity of underlying conditions, disease severity, and/or multiple comorbidities. 69 Studies that focus on conditionindependent outcomes could include measures of perceptions of health care quality or health-related quality of life, both of which are particularly important for a group of children who interface so frequently with the medical system.…”

Section: Research Agendamentioning

confidence: 99%

Children With Medical Complexity: An Emerging Population for Clinical and Research Initiatives

et al. 2011

Self Cite

View full text Add to dashboard Cite

Children with medical complexity (CMC) have medical fragility and intensive care needs that are not easily met by existing health care models. CMC may have a congenital or acquired multisystem disease, a severe neurologic condition with marked functional impairment, and/or technology dependence for activities of daily living. Although these children are at risk of poor health and family outcomes, there are few well-characterized clinical initiatives and research efforts devoted to improving their care. In this article, we present a definitional framework of CMC that consists of substantial family-identified service needs, characteristic chronic and severe conditions, functional limitations, and high health care use. We explore the diversity of existing care models and apply the principles of the chronic care model to address the clinical needs of CMC. Finally, we suggest a research agenda that uses a uniform definition to accurately describe the population and to evaluate outcomes from the perspectives of the child, the family, and the broader health care system. Pediatrics 2011;127:529-538Since 1998, the Maternal and Child Health Bureau has defined children with special health care needs (CSHCN) as those children who have or are at increased risk of a chronic physical, developmental, behavioral, or emotional condition and require health care and related services of a type or amount beyond that required by children generally. 1 An extensive process informed the development of an intentionally broad and inclusive CSHCN definition for the definition to be meaningful for broad program planning and development. Although 13% to 18% of children are considered to have special needs (excluding those who are "at risk" for special needs), 2 there is considerable variation in medical complexity, functional limitations, and resource need among CSHCN. 3,4 One important subgroup is the children who are the most medically fragile and have the most intensive health care needs. Examples vary and include children who have a congenital or acquired multisystem disease, a severe neurologic condition with marked functional impairment, or patients with cancer/cancer survivors with ongoing disability in multiple areas. Terms traditionally used to describe this subgroup include a combination of children with 1 or more of the following terms: complex, chronic, medical, conditions, and/or needs (eg, complex chronic conditions [CCCs], 5 complex medical needs, 6 complex medical conditions, 7 and complex health conditions 8 ), as well as medically complex children. 9,10 In this article, we use the term "children with medical complexity" (CMC). The rationales are that it uses "person-first" terminology and refers to the extra time, expertise, and resources necessary to achieve optimal health outcomes for these children. AUTHORS:

show abstract

Section: Research Agendamentioning

confidence: 99%

Children With Medical Complexity: An Emerging Population for Clinical and Research Initiatives

et al. 2011

Self Cite

View full text Add to dashboard Cite

show abstract

“…These are patients with gastroparesis, microgastria, postfundoplication syndrome, failed fundoplication, or gastroesophageal reflux with aspiration risk in whom fundoplication could not be performed [10,16,[23][24][25]. Transpyloric feedings may also be better tolerated than gastric feedings in patients with increased intra-abdominal pressure (eg, caused by ascites, peritoneal dialysis, mechanical ventilation, and chronic cough) [10, 26•].…”

Section: Indications For Gj Tube In Childrenmentioning

confidence: 99%

“…One of the main indications for use of GJ tube feeding is to prevent aspiration, particularly in neurologically impaired children, in whom it is reported to be as effective as fundoplication for this purpose [13••, 14-16]. However, GJ tube use has been associated with many complications, most of which are mechanical in nature [16,17]. Many of these complications can be managed by replacing a dysfunctional GJ tube, and can be prevented by replacing the GJ tube at regular intervals.…”

Section: Introductionmentioning

confidence: 99%

Frequency and Methods of Gastrojejunal Tube Replacement in Children

Shah

Klooster

Yanni

et al. 2010

Curr Gastroenterol Rep

View full text Add to dashboard Cite

Gastrojejunal (GJ) tubes are increasingly used for enteral feeding in children in whom gastric feeding either is not tolerated or is contraindicated. The most common complications associated with GJ tube use are mechanical failure (clogging, cracking, deterioration) and dislodgement. Less common, but more significant, complications are bowel perforation, aspiration, and feeding intolerance. Some of these complications may be prevented by replacing GJ tubes at regular intervals. Methods to direct a GJ tube include 1) guidewire, 2) gastroduodenoscopy-guidewire, 3) esophagogastroduodenoscopy-forceps, and 4) fluoroscopy-guidewire. Clinical experience to determine the ideal method and optimal timing of GJ tube replacement is evolving. GJ tube replacement using a guidewire through the prior GJ tube, without endoscopy, fluoroscopy, or sedation, is the least risky method, but is also the least likely to be successful.

show abstract

“…35 Finally, evidence to guide the provision of optimal inpatient health care for medically complex children remains very limited. High-quality research into the indications, complications, and outcomes of the more common technologyassistance procedures (eg, gastrostomy tubes, tracheostomies, CSF shunts 18,[36][37][38] ), coupled with dissemination of these findings, could substantially improve care for these children.…”

Section: Discussionmentioning

confidence: 99%

“…HCUP KID includes nationally representative hospital discharges for children on the basis of a random 80% sample of pediatric discharges and 10% of uncomplicated births. Each data set includes weighted discharges (6.657, 7.291, 7.409, and 7.559 million, respectively) from hospitals (2521, 2784, 3438, and 3739, respectively) across various states (22,27,36, and 38, respectively). The HCUP KID sampling frame changed over time; the addition of more states and hospitals in later years and exclusion of short-term rehabilitation hospitals after 1997 has led to a more representative sample.…”

Section: Study Design and Settingmentioning

confidence: 99%

Children With Complex Chronic Conditions in Inpatient Hospital Settings in the United States

2010

PEDIATRICS

View full text Add to dashboard Cite

OBJECTIVES-Hospitalized children are perceived to be increasingly medically complex, but no such trend has been documented. The objective of this study was to determine whether the proportion of pediatric inpatient use that is attributable to patients with a diagnosis of one or more complex chronic condition (CCC) has increased over time and to assess the degree to which CCC hospitalizations are associated with attributes that are consistent with heightened medical complexity.METHODS-A retrospective observational study that used the 1997, 2000, 2003, and 2006 Kids Inpatient Databases examined US hospitalizations for children. Attributes of medical complexity included hospital admissions, length of stay, total charges, technology-assistance procedures, and mortality risk. RESULTS-The proportion of inpatient pediatric admissions, days, and charges increased from 1997 to 2006 for any CCC and for every CCC group except hematology. CCCs accounted for 8.9% of US pediatric admissions in 1997 and 10.1% of admissions in 2006. These admissions used 22.7% to 26.1% of pediatric hospital days, used 37.1% to 40.6% of pediatric hospital charges, accounted for 41.9% to 43.2% of deaths, and (for 2006) used 73% to 92% of different forms of technologyassistance procedures. As the number of CCCs for a given admission increased, all markers of use increased.CONCLUSIONS-CCC-associated hospitalizations compose an increasing proportion of inpatient care and resource use. Future research should seek to improve methods to identify the population of medically complex children, monitor their increasing inpatient use, and assess whether current systems of care are meeting their needs. NIH Public Access Author ManuscriptPediatrics. Author manuscript; available in PMC 2010 October 22. Chronic illness accounts for the majority of children's hospital days and dollars. 4 A smaller set of CSHCN, termed medically complex children, are perceived to use a disproportionate amount of resources, particularly in the inpatient and tertiary care settings. 5 Consistent and complete identification criteria of this subpopulation for administrative, clinical, and research purposes, however, remains elusive. 5-7 A prototypical medically complex child has a diversity of conditions and multisystem disease; may be technology-dependent; has frequent inpatient admissions; and requires multiple medications, multiple subspecialists, and optimal care coordination across inpatient and outpatient settings. 5 Previous work describing the 6.5% of children with disabilities, 8,9 the nearly 5% of children with multiple chronic conditions, 10 or children with technology dependence 5 likely described sets of children with some degree of medical complexity.For accurate attribution of health care use of medically complex children, an operational definition is needed for use in administrative data sets. One potential method to study medically complex children is to group International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes so...

show abstract

Impact of Fundoplication Versus Gastrojejunal Feeding Tubes on Mortality and in Preventing Aspiration Pneumonia in Young Children With Neurologic Impairment Who Have Gastroesophageal Reflux Disease

Cited by 108 publications

References 31 publications

Children With Medical Complexity: An Emerging Population for Clinical and Research Initiatives

Children With Medical Complexity: An Emerging Population for Clinical and Research Initiatives

Frequency and Methods of Gastrojejunal Tube Replacement in Children

Children With Complex Chronic Conditions in Inpatient Hospital Settings in the United States

Contact Info

Product

Resources

About