Tube Feeding in Neurologically Disabled Children: Hot Topics and New Directions

Dipasquale, Valeria; Aumar, Madeleine; Ley, Delphine; Antoine, Matthieu; Romano, Claudio; Gottrand, Frédéric

doi:10.3390/nu14183831

Cited by 8 publications

(10 citation statements)

References 51 publications

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“…A significant number of children with NIs encounter difficulties with swallowing and gastrointestinal symptoms. As a result, these children frequently necessitate tube feeding to enhance their nutritional status and promote healthy growth, ensure sufficient fluid intake, and enhance adherence to medication regimens (21,22). Liu et al (23) conducted a study that revealed a positive correlation between NI and the occurrence of both early and late complications associated with gastrostomy.…”

Section: Discussionmentioning

confidence: 99%

Impact of Scoliosis Severity on Gastrostomy-Related Complications in Children

Toker Kurtmen,

Nalli,

Oztan

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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Objectives: This study aimed to determine the relationship between scoliosis and risk of developing complications in patients who underwent gastrostomy. Methods: Patients who underwent percutaneous endoscopic gastrostomy (PEG) or surgical gastrostomy (SG) between 2012 and 2022 were included. Leakage, discharge, granuloma, and hyperemia were considered minor complications, while visceral injury, ileus, and re-do surgery were considered major complications. The degree of scoliosis was calculated using the Cobb angle. The SG and PEG groups were compared by evaluating the complications and their correlation with scoliosis. Results: A total of 104 patients with a mean age of 5.0 ± 5.3 were included; 58% of patients were treated with SG. Patients in the SG group were younger (P < 0.001). Minor complications were significantly more common in the PEG group (P = 0.018). There was no difference between the groups in terms of major complications (P = 1.000). Scoliosis was observed in 32.7% of the patients (n = 34). In the SG group, no correlation was found between the Cobb angle and the frequency of minor (P = 0.173) or major complications (P = 0.305). There was no significant difference between the Cobb angles of patients with and without minor complications in the PEG group (P = 0.478); the Cobb angles of patients with major complications (75°) were significantly higher than those without (36°) (P = 0.030). Conclusion: Gastrostomy is important for weight gain and nutritional needs of children. This study showed that the risk of complications in SGs did not correlate with the degree of scoliosis and that the risk of major complications in PEGs increased in patients with a high degree of scoliosis.

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Section: Discussionmentioning

confidence: 99%

Impact of Scoliosis Severity on Gastrostomy-Related Complications in Children

Toker Kurtmen,

Nalli,

Oztan

et al. 2023

Journal of Pediatric Gastroenterology &Amp; Nutrition

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“…Not surprisingly, the type of enteral formula in children with ND did not predict the normalization of nutritional status. The choice of enteral formula comes from different factors, including the patient’s age, nutritional requirements, type of enteral access, and child’s tolerance to feeds [ 7 , 20 , 21 ]. A standard (1.0 kcal/mL) polymeric age-appropriate formula including fiber is recommended as the initial enteral feed after 1 year of age [ 7 ].…”

Section: Discussionmentioning

confidence: 99%

Early Tube Feeding Improves Nutritional Outcomes in Children with Neurological Disabilities: A Retrospective Cohort Study

Dipasquale¹,

Cucinotta²,

Alibrandi

et al. 2023

Nutrients

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Tube feeding is a life-saving treatment for children with neurological disabilities (ND), who often suffer from malnutrition and feeding disorders. Nonetheless, it is still not widely used. Our aim was to evaluate the outcomes of exclusive tube feeding in a cohort of ND children. All consecutive ND children who started tube feeding at our center within the last 5 years were included in this retrospective study. Weight-for-age, body mass index (BMI), mid-upper arm circumference (MUAC) Z-scores, and symptoms were collected at baseline (V0), 6 (V1), and 12 months (V2) after gastrostomy placement. Fifty children (62% males) were included. The ND-underlying disease was genetic (n = 29, 58%), hypoxic-ischemic encephalopathy (n = 17, 34%), or metabolic (n = 4, 8%). Indications for tube feeding were malnutrition (n = 35, 70%), recurrent respiratory infections (n = 11, 22%), or both (n = 4, 8%). Enteral formulae were polymeric (n = 29, 58%), semi-elemental (n = 17, 34%), hypercaloric (n = 3, 6%), or elemental (n = 1, 2%). Homemade blended feed was offered to three children (6%) in addition to the formula. Weight and BMI increased over the study period. Except for constipation, all symptoms (cough, vomiting, and diarrhea) improved at 6 and 12 months (p < 0.05). Non-serious complications (n = 8; track disruption, granuloma, and skin infection) were observed. Longer disease duration (p < 0.001) at the start of tube feeding was associated with the absence of normalization of nutritional status (BMI Z-score > 2 SD) at 12 months. Tube feeding with commercially available enteral formulae should be started as early as possible for better outcomes.

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“…Enteral nutrition can be performed as intermittent boluses or continuously (165). Children with increased caloric requirements or poor volume tolerance may benefit from a combination of continuous nocturnal enteral nutrition combined with multiple boluses during the day (166).…”

Section: Enteral Feeding By Tubementioning

confidence: 99%

“…For neurologically impaired children with PEG, some natural food options that can be incorporated into their diet include: fruits and vegetables that are rich in vitamins, minerals, and antioxidants and can be easily blended into their feeding regimen; whole grains such as rice, oats, and quinoa, which provide carbohydrates, fiber, and essential nutrients; lean protein sources such as chicken, fish, and eggs that provide essential amino acids; and healthy fats such as avocado, nuts, and seeds that are rich in omega-3 fatty acids. Dairy products such as milk, yogurt, and cheeses are also good sources of calcium for bone health (166,173,174). Formulas containing natural foods have been shown to enhance tolerance and feeding outcomes, improve family participation, and increase compliance during mealtimes (175).…”

Section: Enteral Feeding By Tubementioning

confidence: 99%

Gut dysmotility in children with neurological impairment: the nutritional management

et al. 2023

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Intestinal motility disorders represent a frequent problem in children with neurological impairment. These conditions are characterized by abnormal movements of the gut, which can result in symptoms such as constipation, diarrhea, reflux, and vomiting. The underlying mechanisms leading to dysmotility are various, and the clinical manifestations are often nonspecific. Nutritional management is an important aspect of care for children with gut dysmotility, as it can help to improve their quality of life. Oral feeding, when safe and in the absence of risk of ingestion or severe dysphagia, should always be encouraged. When oral nutrition is insufficient or potentially harmful, it is necessary to switch to an enteral by tube or parenteral nutrition before the onset of malnutrition. In most cases, children with severe gut dysmotility may require feeding via a permanent gastrostomy tube to ensure adequate nutrition and hydration. Drugs may be necessary to help manage gut dysmotility, such as laxatives, anticholinergics and prokinetic agents. Nutritional management of patients with neurological impairment often requires an individualized care plan to optimize growth and nutrition and to improve overall health outcomes. This review tries to sum up most significant neurogenetic and neurometabolic disorders associated with gut dysmotility that may require a specific multidisciplinary care, identifying a proposal of nutritional and medical management.

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Tube Feeding in Neurologically Disabled Children: Hot Topics and New Directions

Cited by 8 publications

References 51 publications

Impact of Scoliosis Severity on Gastrostomy-Related Complications in Children

Impact of Scoliosis Severity on Gastrostomy-Related Complications in Children

Early Tube Feeding Improves Nutritional Outcomes in Children with Neurological Disabilities: A Retrospective Cohort Study

Gut dysmotility in children with neurological impairment: the nutritional management

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