Nutrition Via Jejunostomy in Refractory Hyperemesis Gravidarum

Hyperemesis Gravidarum: A Current Review

“…An extreme alternative to nasogastric tube nutrition is treatment via a jejunostomy or percutaneous endoscopic gastrostomy (PEG). 84,85 Parenteral Nutrition van Stuijvenberg et al 74 assessed the nutritional status of 20 patients with hyperemesis gravidarum with gestational age-matched controls and noted that more than 60% of patients had suboptimal biochemical status of thiamine, riboflavin, vitamin B 6 , vitamin A, and retinol-binding protein. Treatment consisting of intravenous normal saline solution together with an ampule of intravenous multivitamin preparation administered over 8 hours was continued for 10 days, with oral fluid and food restriction.…”

Hyperemesis Gravidarum and Fetal Outcome

“…Results: Significantly higher incidences of being nonwhite (33% vs 16%; p Ͻ .05) and of attaining post-high school education (60% vs 38%) were noted in the HG group, relative to controls. Mothers in the control group experienced greater gestational weight gain, 14.9 Ϯ 0.3 kg (mean Ϯ SEM) relative to mothers in the HG group (10.6 Ϯ 1.3 kg). Infants from HG pregnancies manifested significantly lower birth weight (3.23 Ϯ 0.09 kg vs 3.52 Ϯ 0.03 kg), younger gestational age (38.4 Ϯ 0.3 weeks vs 39.7 Ϯ 0.1 weeks), and a greater length of hospital stay (2.9 Ϯ 0.5 days vs 1.8 Ϯ 0.1 day), relative to infants from the control group.…”

“…Several reports have focused on the means and cost of nutrition support in HG, including parenteral nutrition, 13 open jejunostomy, 14 percutaneous endoscopic gastrostomy and jejunostomy, 15,16 and nasogastric feeding tubes. 17 Indeed, the cost of both treatment and dysfunction associated with HG can be significant.…”

Percutaneous Endoscopic Jejunostomy Tube Placement for Treatment of Severe Hyperemesis Gravidarum in Pregnancy

“…The first case of PEGJ tube placement for enteral feeding in the setting of refractory HG was described in 1997. 4 Another report soon followed of 2 cases performed at the same institution and then a subse quent case series analyzing 5 patients from 1998 to 2005. 5,6 All of which deemed the procedure a safe and effective advanced treatment for refractory HG.…”