Tubefeeding and Mortality in Children With Severe Disabilities and Mental Retardation

Abstract

We hypothesize that the increased mortality associated with tubefeeding may be attributable to a differential increase in pulmonary disease secondary to overly vigorous nutritional maintenance and subsequent aspiration after tube placement. For children with tracheostomy this risk may be reduced. If tracheostomy proves to be associated with a relatively more favorable outcome for tubefeeding, we hypothesize that it would reflect the benefits of tracheostomy in allowing access to the airway for suctioning and ventilation. Given the observed higher mortality rates among the less severely disabled children who are tubefed and the substantial costs associated with tubefeeding, a prospective, controlled study may be clinically indicated, ethically justifiable, and economically warranted.

Life expectancy of children in vegetative and minimally conscious states

“…Mobile patients are also less likely to have severe contractures, chest wall deformities, or scoliosis, which, when present, contribute to reduced ventilatory function [44][45][46]. Mobile patients are more likely to be fed orally than by gastrostomy tube and, as the present study and other studies [26] have demonstrated, oral feeding is associated with improved survival.…”

“…Thus, we could not directly compare the results of this study to our earlier studies of severely disabled children [26] or to children in a persistent [4] or permanent [17] VS. However, a comparison of the Kaplan-Meyer survival curves in these previous studies reveals that the patients in the current study have had a longer survival.…”

“…Although mobility is associated with improved survival in various populations of neurologically affected patients [23][24][25][26][27][28][29][30], the reasons for this improved survival have not been systematically studied. Mobility implies an intact or partially intact corticospinal tract and lower motor neuron function as a result of sufficiently preserved neurons and their descending pathways.…”

“…For patients with severe developmental disabilities, mobility proves to be a significant predictor of reduced mortality risk [23][24][25][26][27][28][29][30]. Mobility was defined as the presence of spontaneous or elicited movement of the trunk or upper or lower extremities, specifically the ability to lift one's head or chest when lying on the stomach, roll from front to back or back to front, or maintain the sitting position for at least 5 minutes.…”

“…This approach has been widely used in similar work [24][25][26]. The total patient-months contributed by 5,075 individuals during the study period was 200,057.5.…”