Medical, surgical, and health outcomes of gastrostomy feeding

Abstract

A prospective controlled study with repeated measures before and after surgery examined the medical, surgical, and health outcomes of gastrostomy for children with disabilities at a tertiary paediatric referral centre in the North Thames area, UK. Anthropometric measures included weight, mid-upperarm and head circumference. Five-day prospective food diaries were completed and data on physical health and surgical outcomes recorded. Seventy-six children participated and underwent gastrostomy (44 males, 32 females; median age 3y 4mo, range 4mo-17y 5mo), and 35/76 required an anti-reflux procedure. Categories of disability were: cerebral palsy (32/76), syndrome of chromosomal or other genetic origin (25/76), slowly progressive degenerative disease (11/76), and unconfirmed diagnosis (8/76). Most children had gross motor difficulties (99%) and were non-ambulant (83%). Oromotor problems were identified in 78% of children, 69% aspirated, and 65% were fed nasogastrically before surgery. The mean weight before surgery was -2.84 standard deviation score (SDS; SD 2.21, range -9.8 to 3.4). Two-thirds of children achieved catchup growth postoperatively: weight-for-age (mean difference 0.51 SDS, 95% CI 0.23-0.79, p=0.001) and mid-upper arm circumference (mean difference 1.12cm, 95% confidence interval 0.50-1.75, p=0.001). Health gains included a reduction in drooling, secretions, vomiting, and constipation. Major surgical complications were found in 13/74 children. The study provides evidence that catch-up growth and health gains are possible following gastrostomy.

Psychosocial aspects of feeding children with neurodisability

“…Moreover, it is better to prepare families for some of the possible negative aspects of gastrostomy feeding as caregivers will have to learn new nursing procedures and there may be side-effects of surgery. 7 Not all anxiety about tube feeding is psychological, however, and parents may have concerns about incurring additional costs associated with tube feeding and its affordability, particularly where equipment and feeds are not provided as part of a health plan or health service. Here, financial advice may be necessary.…”

“…The demands of care can be high in this population of children as they are frequently ill and require numerous visits to health professionals and periods of hospitalization. 7 Frequent hospital appointments, because of the complexity of children's needs, and the lack of integrated services, in some cases, can also create additional demands on children and their caregivers, pointing to the importance of the role of key workers in coordinating children's care. 8 Research into the benefits of gastrostomy tube feeding reports improvements in health and weight gain 7,9 and decreased stress, as experienced by caregivers.…”

“…7 Frequent hospital appointments, because of the complexity of children's needs, and the lack of integrated services, in some cases, can also create additional demands on children and their caregivers, pointing to the importance of the role of key workers in coordinating children's care. 8 Research into the benefits of gastrostomy tube feeding reports improvements in health and weight gain 7,9 and decreased stress, as experienced by caregivers. 10,11 Parents also report a reduction in the amount of time spent feeding and ease of administering medication and liquids (by tube rather than orally).…”

Risk owners and risk managers: Dealing with the complexity of feeding children with neurodevelopmental disability

“…We utilise a study of professional and parental interactions that occurred at specific points in the patient referral pathway during the course of a research study evaluating the effectiveness of gastrostomy feeding interventions coordinated by one of the authors (reported in Craig et al 2006). We draw on observations of clinical consultations following a referral for gastrostomy and referral letters in patients' notes, in addition to interviews with parents (reported in Craig 2004;Craig, Scambler & Spitz 2003).…”

Gastrostomy tube feeding: when to start, what to feed and how to stop

“…Gastrostomy feeding has been found to improve weight and mid-arm circumference (Cook et al, 2005;Sullivan et al, 2005;Craig et al, 2006;Ramelli et al, 2007), reduce feeding time (Cook et al, 2005;Sullivan et al, 2005), improve the quality of life of caregivers and children (Sullivan et al, 2004;Cook et al, 2005;Kindermann et al, 2008;Mahant et al, 2009), and result in other health gains (Sullivan et al, 2005). The prospect of gastrostomy feeding, however, is seen as a major intervention by parents and therefore detailed preparation and discussion are needed.…”