Paediatric emergency department presentations due to feeding tube complications in children with cerebral palsy

Abstract

Aim: To describe the characteristics of emergency department (ED) presentations due to complications from gastrostomy or gastrojejunal feeding tubes among children with cerebral palsy (CP), the complexity of complications and the management approaches taken. Methods: The Victorian CP Register was linked to the ED databases of Victoria's two tertiary paediatric hospitals, and data on presentations due to feeding tube complications were identified based on discharge diagnosis codes. Additional data on presentations were extracted from medical records. Results: Over 5 years, there were 234 ED presentations due to feeding tube-related complaints among a CP cohort (n = 2183). ED notes were located for 183 of the 234 presentations. The majority of presentations (90%) involved children with severe gross motor impairment. A total of 46% of presentations (n = 84) was triaged as lower urgency, and 68% (n = 124) took place between 08:00 am and 06:00 pm. The most common presenting complaint was tube dislodgement (n = 105; 70%). No investigations were recorded in the majority of cases, and in almost 90% of cases, the feeding tube was successfully replaced in the ED, usually by an ED physician (n = 74) and less frequently by a surgeon (n = 9), gastroenterologist (n = 2) or nurse (n = 8); 9% (n = 17) resulted in a hospital admission. Conclusions: Most ED presentations due to feeding tube complaints in children with CP are in children with severe gross motor impairment but are able to be managed in the ED. As such, it is likely that care givers and other health professionals could manage some of the complications experienced in primary health-care settings closer to home.

Long-Term Analysis of Respiratory-Related Complications Following Gastrostomy Placement with or without Fundoplication in Neurologically Impaired Children: A Retrospective Cohort Study

“…The exclusion of other types of complications in their study, especially those related to infection, might account for the higher incidence in our series. The rates of complications observed in our series is similar to those previously described [19,20], although we might have lost some minor complications treated by local hospital and general practitioners.…”

Emergency Presentations for Gastrostomy Complications Are Similar in Adults and Children

“…To our knowledge, this is the first study to compare GT complications in adults and children presenting to ED. Complications of gastrostomy tubes are well described (7,(13)(14)(15); however, there remains a paucity of literature on how complications differ between adults and children, long-term frequency, and the impact of a gastrostomy service on ED presentations. For both adults and children, complications seen in ED were predominantly infectious or mechanical, consistent with the literature (13,15).…”

“…Major complications in adults range from 0.4% to 21.8% (4,5,7–10) and 3.3% to 12.6% in children (2,11–15). Minor complications range from 2.7% to 64.7% in adults (4,5,7–10) and 16.4% to 47.7% in children (2,11–15).…”

“…Minor complications are classified as: tube displacement with uneventful re‐insertion, minor wound infection, and peristomal leakage (4–6). Major complications in adults range from 0.4% to 21.8% (4,5,7–10) and 3.3% to 12.6% in children (2,11–15). Minor complications range from 2.7% to 64.7% in adults (4,5,7–10) and 16.4% to 47.7% in children (2,11–15).…”

Top-ten tips for managing nutritional issues and gastrointestinal symptoms in children with neurological impairment

“…The most common tube type was gastrostomy tube (n = 82.5%). Notably, in almost 90% of cases, the feeding tube was successfully replaced in the emergency department, with no need of hospitalization [44]. Children with NI and their caregivers have reduced health-related quality of life (HRQoL), as a consequence of feeding difficulties and gastrointestinal disorders [1].…”