Cost-Effectiveness Analysis of the Surgical Management of Infants Less than One Year of Age with Feeding Difficulties

Yu, Yangyang R.; Cunningham, Megan E.; DeMello, Annalyn S.; Chiou, Eric; Kougias, Panagiotis; Wesson, David E.; Brandt, Mary L.; López, Mónica E.

doi:10.1016/j.jpedsurg.2019.09.076

Cited by 7 publications

(7 citation statements)

References 26 publications

Supporting

Mentioning

Contrasting

Unclassified

Order By: Relevance

“…Interestingly, recently published data suggests that if NF fails and patients are free from GERD symptoms on jejunal feeding, further anti-reflux surgical intervention should be avoided ( 24 ). Another recent study suggests that EN alone, without combined surgery, could improve digestive symptoms ( 25 ). Furthermore, the combination of PEG with NF has been considered neither mandatory nor efficacious in preventing GERD in infants with NDs ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

Enteral formula compared to Nissen-Fundoplication: Data from a retrospective analysis on tolerance, utility, applicability, and safeness in children with neurological diseases

Trovato

Capriati²,

Bolasco³

et al. 2023

Front. Nutr.

View full text Add to dashboard Cite

Objectives and studyApproximately 46–90% of children with neurological disorders (NDs) suffer from gastrointestinal diseases, such as gastro-esophageal reflux disease (GERD), constipation, or malnutrition. Therefore, enteral feeding is often necessary to achieve nutritional requirements. The treatment of GERD could be based on pharmacological therapy, nutritional treatment (changing the type of formula), or surgical treatment (Nissen Fundoplication, NF). The aim of this study was to describe and compare resource consumption between NE based on different formulas and NF in patients with ND.MethodsWe performed a retrospective analysis on all children with neurological damage (age: 29 days−17 years) treated from January 2009 to January 2019 due to nutritional problems and food and/or gastrointestinal intolerances. For all patients, demographic and anthropometric characteristics, symptoms, type of nutrition (formula and enteral access), and number and type of outpatient or emergency room visits were collected. Patients with <24 months of age at the closing of the database and with <24 months of follow-up were excluded.ResultsOut of 376 children, 309 children (M: 158; median age: 4 IQR 1–10) were enrolled, among which, 65 patients (NF group M: 33; median age: 5.3 IQR 1.8–10.7) underwent NF. Vomit, GERD, and dysphagia were more represented in the NF group (p < 0.05). Our analysis shows that the NF group seems to present a lower number of hospitalization and a lower number of visits for non-GI disorders, but a higher number of visits for GI disorders compared to non-NF. In the NF group, a higher prevalence of the use of amino-acid-based formula and free diet is observed, with a trend for the lower prevalence of casein-based or whey+casein-based formula (Fisher test p = 0.072). The median cost of a patient enrolled in the database is € 19,515 ± 540 ($ 20,742.32 ± 573.96) per year, with no significant difference between the two groups. Regarding formula, at baseline, 76 children consumed a free diet, 24 a casein-based formula, 139 a whey+casein-based formula, 46 a whey-based formula, and 24 an amino-acid-based formula.ConclusionsIn conclusion, compared to EN, NF may not improve the clinical aspect and related costs in children with NDs. Considering the psychological and QoL burden for patients, in a “step-up” strategy, EN could be proposed as an efficient alternative to NF.

show abstract

Section: Discussionmentioning

confidence: 99%

Enteral formula compared to Nissen-Fundoplication: Data from a retrospective analysis on tolerance, utility, applicability, and safeness in children with neurological diseases

Trovato

Capriati²,

Bolasco³

et al. 2023

Front. Nutr.

View full text Add to dashboard Cite

show abstract

“…A study on infants with feeding difficulties showed that only 12% required change to gastrojejunal tube. However, most had underlying cardiac disease ( 69 ). When comparing children that ultimately require gastrojejunal feeding, there was no difference in preoperative patient characteristics, hospitalization rates, or diagnostic evaluations at gastrostomy insertion ( 70 ).…”

Section: Risk Factors For Respiratory Illnessmentioning

confidence: 99%

Evaluation and Management of Respiratory Illness in Children With Cerebral Palsy

et al. 2020

View full text Add to dashboard Cite

Cerebral palsy (CP) is the most common cause of disability in childhood. Respiratory illness is the most common cause of mortality, morbidity, and poor quality of life in the most severely affected children. Respiratory illness is caused by multiple and combined factors. This review describes these factors and discusses assessments and treatments. Oropharyngeal dysphagia causes pulmonary aspiration of food, drink, and saliva. Speech pathology assessments evaluate safety and adequacy of nutritional intake. Management is holistic and may include dental care, and interventions to improve nutritional intake, and ease, and efficiency of feeding. Behavioral, medical, and surgical approaches to drooling aim to reduce salivary aspiration. Gastrointestinal dysfunction, leading to aspiration from reflux, should be assessed objectively, and may be managed by lifestyle changes, medications, or surgical interventions. The motor disorder that defines cerebral palsy may impair fitness, breathing mechanics, effective coughing, and cause scoliosis in individuals with severe impairments; therefore, interventions should maximize physical, musculoskeletal functions. Airway clearance techniques help to clear secretions. Upper airway obstruction may be treated with medications and/or surgery. Malnutrition leads to poor general health and susceptibility to infection, and improved nutritional intake may improve not only respiratory health but also constipation, gastroesophageal reflux, and participation in activities. There is some evidence that children with CP carry pathogenic bacteria. Prophylactic antibiotics may be considered for children with recurrent exacerbations. Uncontrolled seizures place children with CP at risk of respiratory illness by increasing their risk of salivary aspiration; therefore optimal control of epilepsy may reduce respiratory illness. Respiratory illnesses in children with CP are sometimes diagnosed as asthma; a short trial of asthma medications may be considered, but should be discontinued if ineffective. Overall, management of respiratory illness in children with CP is complex and needs well-coordinated multidisciplinary teams who communicate clearly with families. Regular immunizations, including annual influenza vaccination, should be encouraged, as well as good oral hygiene. Treatments should aim to improve quality of life for children and families and reduce burden of care for carers.

show abstract

“…O refluxo é comum em mais de dois terços das crianças saudáveis menores de 1 ano e costuma se resolver espontaneamente. Quando o mesmo traz sintomas incômodos ou complicações, como aversão ou intolerância à ingesta oral, deve ser visto como doença, pois pode afetar a qualidade de vida, uma vez que dificulta a alimentação e o ganho de peso (YU et al, 2020). necessário avaliação caso a caso para a indicação de fundoplicatura no mesmo ato operatório da gastrostomia, através de investigação pré-operatória de doença do refluxo e refratariedade às medicações, mesmo em pacientes neuropatas.…”

Section: Confecção De Válvula Antirrefluxounclassified

“…Por isso, a confecção de válvula antirrefluxo pode ser considerada no mesmo ato da gastrostomia (BURD, PRICE e WHALEN, 2002). Yu et al (2020), em seu estudo prospectivo analisaram, por 1 ano, crianças menores de 1 ano com diversas patologias, incluindo neuropatia que tinham dificuldades alimentares e refluxo e foram indicadas para gastrostomia. Ao final, a maioria dos pacientes que fez apenas a gastrostomia evoluiu com melhora da qualidade de vida, não necessitando de fundoplicatura gástrica ou sonda gastrojejunal (YU et al, 2020).…”

Section: Confecção De Válvula Antirrefluxounclassified

See 1 more Smart Citation

Desfechos de pacientes neuropatas com gastrostomia tratados em unidade de terapia intensiva neonatal em hospital público de ensino

Oliveira¹

View full text Add to dashboard Cite

show abstract

Cost-Effectiveness Analysis of the Surgical Management of Infants Less than One Year of Age with Feeding Difficulties

Cited by 7 publications

References 26 publications

Enteral formula compared to Nissen-Fundoplication: Data from a retrospective analysis on tolerance, utility, applicability, and safeness in children with neurological diseases

Enteral formula compared to Nissen-Fundoplication: Data from a retrospective analysis on tolerance, utility, applicability, and safeness in children with neurological diseases

Evaluation and Management of Respiratory Illness in Children With Cerebral Palsy

Desfechos de pacientes neuropatas com gastrostomia tratados em unidade de terapia intensiva neonatal em hospital público de ensino

Contact Info

Product

Resources

About