A Literature Review of Feeding Disorders in Children with Tracheostomies and Ventilators

Sobotka, Sarah A.; Laudon, Sarah; Jackson, Arwen; Harendt, Shaunda; Baker, Christopher D.

doi:10.3928/19382359-20220504-05

Cited by 9 publications

(11 citation statements)

References 36 publications

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“…Another study looked at 5‐year outcomes of children with IMV and identified a high association between neurocognitive function and ventilator dependence, although cognitive assessment was determined by chart review and team consensus, without objective measures 17 . Mechanistically, it is thought that prolonged oral intubation and the presence of a tracheostomy may limit essential early speech and feeding opportunities, and increase likelihood of feeding problems and impaired oral motor skills underlying language expression 18–20 …”

Section: Introductionmentioning

confidence: 99%

“…17 Mechanistically, it is thought that prolonged oral intubation and the presence of a tracheostomy may limit essential early speech and feeding opportunities, and increase likelihood of feeding problems and impaired oral motor skills underlying language expression. [18][19][20] As a whole, the developmental outcomes of children with IMV have been studied within larger premature cohorts, and have shown greater risk for developmental delays than other prematurely born infants. However, the extent of these delays, their distribution, trajectories, and protective or confounding influence across diverse populations are yet unknown.…”

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confidence: 99%

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Early childhood developmental skills of children with tracheostomies and ventilators recently discharged home

Sobotka

Lynch

Msall

et al. 2022

Pediatric Pulmonology

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Background Infants who survive prematurity and critical illnesses but require ongoing invasive mechanical ventilation (IMV) are at high risk for developmental disabilities. However, their detailed developmental profiles are largely unknown. Objective To understand the developmental profiles of a cohort of young children with IMV after hospital‐to‐home transition. Design/methods Developmental testing was completed 1 month after hospital discharge to determine functioning within motor, cognitive, and communicative domains using (1) the Clinical Adaptive Test/Clinical Linguistic and Auditory Milestone Scale (CAT/CLAMS); (2) the Pediatric Evaluation of Disability Inventory Computer Adaptive Test (PEDI‐CAT); and (3) The Warner Initial Developmental Evaluation of Adaptive and Functional Skills (WIDEA‐FS). To complement validated testing, semi‐structured interviews were conducted with parents to understand perceived influences on neurodevelopment. Results Twenty children were evaluated at median (range) age 11 (5–27) months. Nearly half (45%) were male, 40% non‐Hispanic Black, and 25% Hispanic. Sixteen (80%) children were survivors of prematurity. After gestational age correction, median (range) full‐scale developmental quotients (DQ) were 69.5 (8–119): CAT DQ 62.5 (3–113) and CLAMS DQ 71.5 (12–125). Parents described that prolonged restriction within the hospital crib away from caregivers, despite hospital therapists, impedes development. Home environments improve development primarily through increased time with parents, but also play outside of the crib. One month after hospital discharge only 10% were receiving early intervention therapies. Conclusions/significance Children with IMV display wide ranges of neurodevelopmental skills with a majority experiencing substantial delays in motor, communicative, and adaptive functioning. The degree and cross‐domain challenges highlight the need for targeted and timely therapeutic strategies.

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Section: Introductionmentioning

confidence: 99%

mentioning

confidence: 99%

Early childhood developmental skills of children with tracheostomies and ventilators recently discharged home

Sobotka

Lynch

Msall

et al. 2022

Pediatric Pulmonology

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“…This finding may be secondary to multiple factors for which patients with tracheostomies are already at high risk, including feeding aversion and overall medical complexity. 23 A retrospective review of patients enrolled in an intensive tube weaning program found that patients with G-tubes (as opposed to NG tubes in their study) and those with a higher degree of medical complexity took significantly longer to wean from enteral feeding; nearly 40% of their G-tube cohort was unable to discontinue tube feeding at 3-year follow-up. 21 A previous study found that, among children with feeding disorders, those who had a tracheostomy had worse oral feeding skills and meal-time behaviors, had chronic malnutrition, and more often required enteral feedings.…”

Section: Discussionmentioning

confidence: 98%

“…In our study, patients with tracheostomy were found to require G‐tube feeds for a significantly longer period of time compared with those without tracheostomy. This finding may be secondary to multiple factors for which patients with tracheostomies are already at high risk, including feeding aversion and overall medical complexity 23 . A retrospective review of patients enrolled in an intensive tube weaning program found that patients with G‐tubes (as opposed to NG tubes in their study) and those with a higher degree of medical complexity took significantly longer to wean from enteral feeding; nearly 40% of their G‐tube cohort was unable to discontinue tube feeding at 3‐year follow‐up 21 .…”

Section: Discussionmentioning

confidence: 99%

Factors influencing gastrostomy tube feeding duration and nutrition outcomes in pediatric patients with Down syndrome: A descriptive cohort study

Aviles,

Giangiordano,

Evelyn

et al. 2024

J Parenter Enteral Nutr

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BackgroundFeeding difficulty is widely recognized in patients with Down syndrome, and many patients require gastrostomy tube (G‐tube) placement for nutrition. No reliable factors have been identified to predict the expected duration of G‐tube feeds in patients with Down syndrome. This descriptive cohort study aimed to determine the factors affecting the duration of G‐tube feeds. We also investigated change in body mass index (BMI) from G‐tube placement to discontinuation.MethodsMedical records of patients with Down syndrome seen by a pediatric gastroenterologist at a tertiary care center between September 1986 and December 2021 were reviewed. Data collection included demographics, anthropometrics, comorbidities, and feeding route. Comparison was performed between patients who discontinued G‐tube feeds and those who did not.ResultsTwo hundred twenty patients (45% female) were included. The median age at G‐tube placement was 5 months (interquartile range [IQR]: 0.2–1.3 years). There were 113 (51%) patients who discontinued G‐tube feeds, after a median duration of 31.6 months (IQR: 15.6–55.7 months). Tracheostomy was the only covariant associated with a longer duration of G‐tube feeds (158 months vs 53 months; P = 0.002). Neither age at G‐tube placement nor any comorbidities were associated with BMI status at discontinuation of G‐tube.ConclusionIn our cohort of patients with Down syndrome, age at placement of G‐tube did not impact the duration of G‐tube feeds. Most patients who had a G‐tube placed were likely to require enteral feeds for at least 1 year. Those who had a tracheostomy needed their G‐tube for a longer time.

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“…29,30 The gastro-esophageal reflux (GER) disease, dysphagia, delayed gastric emptying and constipation are the most common GI problems of the children with tracheostomy on MV. [31][32][33] 2.1 | Ger disease impairement. [35][36][37][38] In the study of mechanical ventilated critically ill patients, the basal LES pressure was found to be low and a minimal increase in abdominal pressure due to suctioning, straining, coughing may cause frequent reflux episodes.…”

Section: Gi Problems In Children On Himvmentioning

confidence: 99%

Management of gastrointestinal and nutritional problems in children on home invasive mechanical ventilation

Tuna Kirsaçlioğlu

2023

Pediatric Pulmonology

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In recent decades, the patient survival is increased due to advances in intensive care units and development of modern mechanic ventilators. Unfortunately, it is not always possible to wean these children from mechanical ventilation. Recently, after placement a tracheostomy tube, these children can be supported at home with noninvasive or invasive mechanical ventilation. Most of the children who need ventilation support at home have neurological impairment. The nutritional issues and gastrointestinal (GI) complications are well defined in critically ill patients, but there are very limited studies on children with tracheostomy. Considering that majority of the patients have neuromuscular disorders, the nutritional and GI problems of the children with tracheostomy are discussed in light of the knowledge of critically ill patients.

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A Literature Review of Feeding Disorders in Children with Tracheostomies and Ventilators

Cited by 9 publications

References 36 publications

Early childhood developmental skills of children with tracheostomies and ventilators recently discharged home

Early childhood developmental skills of children with tracheostomies and ventilators recently discharged home

Factors influencing gastrostomy tube feeding duration and nutrition outcomes in pediatric patients with Down syndrome: A descriptive cohort study

Management of gastrointestinal and nutritional problems in children on home invasive mechanical ventilation

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