Babies with brain damage who can not swallow: surgical management

Abstract

-Background:Neonates with severe neurological impairment are often unable to swallow, necessitating gastrostomy for feeding. Because of the risk of developing severe reflux, this procedure is often associated with fundoplication. Objective: To assess the safety and efficacy of gastrostomy and Nissen fundoplication in 22 neonates with swallowing difficulties due to serious neurological impairment. Method: All children underwent an initial period of nasogastric feeding and after informed consent underwent gastrostomy and Nissen fundoplication. Results: There were no significant intraoperative complications. There were two cases of postoperative periostomy leakage. Of the 22 neonates 16 were alive four months after surgery. Six neonates died of complications due to underlying disease. Conclusion: We concluded that gastrostomy and Nissen fundoplication are safe procedures and help parents give a better care to these children.Key WOrdS: gastrostomy, newborn, brain damage, fundoplication, gastroesophageal reflux. recém-nascidos com lesão cerebral que não deglutem: manejo cirúrgicoResumo -Introdução: Neonatos com dano neurológico são freqüentemente incapazes de deglutir necessitando de gastrostomia para alimentação. devido ao risco de refluxo grave, esse procedimento é associado à fundoplicatura. Objetivo: Avaliar a segurança e eficácia da gastrostomia com fundoplicatura Nissen em 22 neonatos com dificuldades de deglutição devido à lesão neurológica grave. Método: Todos os neonatos foram submetidos a um período inicial de alimentação por sonda nasogástrica e, após consentimento informado, foram submetidos a gastrostomia com fundoplicatura Nissen. Resultados: Não houve complicações intraoperatórias significativas. Houve dois casos de vazamento pós-operatório da ostomia. dos 22 neonatos, 16 estavam vivos 4 meses após a cirurgia. Seis neonatos morreram por complicações devido à doença de base. Conclusão: A gastrostomia com fundoplicatura Nissen é procedimento seguro e ajuda os pais a darem melhor cuidado a crianças com lesão neurológica.

Profile, recommendation criteria, and outcome of gastrostomy tube insertions in a pediatric teaching hospital

“…According to studies, the main recommendations for gastrostomy are related to the presence of dysphagia 2, 6,8,9,10,13,15 The present study confirms this finding, for 62.5% of the patients analyzed presented with clinical signs of dysphagia (episodes of coughing, throat clearing, or choking related to deglutition/feeding) described in their medical records. However, this value could have been underestimated, since only patients who described clinical signs of dysphagia were included.…”

“…2 However, the nasoenteric tube (NET) is also used with less frequency. 2, 10,11 In disagreement, the present study shows only 5% of the individuals using the NGT. The predominant nutritional pathway in the present patients analyzed was oral ingestion (42.5%), followed by the NET (40.0%).…”

“…6,[8][9][10][11][12] It was followed by malnutrition, 6,9,12,13 craniofacial anomalies, 2,6 oncological diseases, 2,6,9 and prematurity. 9,10 In the present study, several of these were the underlying diseases found, however the majority of patients (77.5%) were diagnosed with encephalopathy. In addition to that, a high incidence of pneumonia (67.5%), seizures (57.5%), and malnutrition (42.5%) was found.…”

“…15 This period of time has no consensus among the studies and may vary from 1 to 3 months, depending on the reference consulted. 10,15 In relation to the respiratory condition in the period before the gastrostomy insertion, almost half of the patients (45%) did not use any respiratory aid. Among the remaining patients, 27.5% were dependent on oxygen or ventilatory support, with an additional 22.5% patients needing invasive support.…”

“…The literature shows that, traditionally, the use of the gastrostomy is initiated 24 hours after its insertion, 10 however, authors such as Srinivasan & Fisher 21 concluded that the earlier the feeding begins, at around 3 hours after the insertion, the greater the efficacy and the lesser the time of hospitalization. There are different studies that agree with these authors on beginning the feeding earlier, although with more caution, recommending starting 3 to 6 hours after the procedure.…”