Oral Feeding Reduces Hospitalizations Compared with Gastrostomy Feeding in Infants and Children Who Aspirate

McSweeney, Maireade E.; Kerr, Jessica; Amirault, Janine; Mitchell, Paul D.; Larson, Kara; Rosen, Rachel

doi:10.1016/j.jpeds.2015.11.028

Cited by 40 publications

(34 citation statements)

References 30 publications

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“…Even with enteral feeding, gastro‐oesophageal reflux and difficulties swallowing saliva could still be associated with aspiration. However, our findings are consistent with previous observations where patients with mixed diagnoses who underwent gastrostomy for risk of aspiration experienced more hospital admissions than those with similar risk who were fed orally . A larger proportion of individuals who were unable to walk were also more likely to be fed enterally and have day‐to‐day respiratory symptoms, indicative of greater clinical severity.…”

Section: Discussionsupporting

confidence: 91%

“…However, our findings are consistent with previous observations where patients with mixed diagnoses who underwent gastrostomy for risk of aspiration experienced more hospital admissions than those with similar risk who were fed orally. 20 A larger proportion of individuals who were unable to walk were also more likely to be fed enterally and have day-to-day respiratory symptoms, indicative of greater clinical severity. Our data indicated a sixfold greater risk for hospital admission for LRTI in those unable to walk compared with those who walked independently, with being able to walk with assistance associated with intermediate risk.…”

Section: Discussionmentioning

confidence: 99%

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Respiratory morbidity in Rett syndrome: an observational study

Mackay

Leonard

Wong

et al. 2018

Develop Med Child Neuro

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Section: Discussionsupporting

confidence: 91%

Section: Discussionmentioning

confidence: 99%

Respiratory morbidity in Rett syndrome: an observational study

Mackay

Leonard

Wong

et al. 2018

Develop Med Child Neuro

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“…With prior literature of patients undergoing either a fundoplication or GJ placement suggesting that anti-reflux procedures may have minimal/no impact on subsequent respiratory related admissions (because the pulmonary complications in the majority of aspirating children are not a result of gastroesophageal reflux but instead because of a lack of thickening of oral feeds or aspiration of saliva), in turn, it makes sense that abnormal swallowing, or aspiration on a swallow study, should not preclude the placement or use of a gastrostomy tube; in fact, one could argue that for oropharyngeal dysphagia, an enteral tube is not even indicated anymore based on prior published data. 9,22,23 …”

Section: Discussionmentioning

confidence: 99%

Preoperative Evaluation Is Not Predictive of Transpyloric Feeding Conversion in Gastrostomy‐dependent Pediatric Patients

McSweeney

Kerr

Amirault

et al. 2018

J. pediatr. gastroenterol. nutr.

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Objectives Limited literature exists as to whether preoperative GT evaluation may predict which patients will go onto require GJ feeding. The goal of this study was to compare the preoperative evaluations between patients maintained on GT feeds versus patients who required conversion to GJ feeds. Methods We identified patients at Boston Children’s Hospital who underwent GT placement and required GJ feeding between 2006–2012. GT patients were matched according to age, neurologic, and cardiac status with GJ converted patients. Preoperative characteristics, rates of total hospitalizations, and respiratory related admissions were reviewed. Results 79 GJ patients (median (IQR): age 15 (4.3, 55.7) months; weight 8.8 (4.6, 14.5) kg) were matched with 79 GT patients (median (IQR): age 14.6 (4.7, 55.7) months; weight 8.5 (5, 13.6) kg). Median time from GT to GJ conversion was 8 (IQR 3, 16) months. Both groups had similar rates of successful preoperative nasogastric feeding trials (GT (84.5%) vs GJ (83.1%), p=1.0), upper GI series (GT (89.1%) vs GJ (93.2%), p=0.73), abnormal videofluoroscopic swallow studies (GT (53.8%) vs GJ (62.2%), p=0.4), and completion of gastric emptying studies (GT (10.1%) vs GJ (5.1%), p=0.22). No differences were seen in preoperative hospitalization rates (p=0.25), respiratory admissions (p=0.36), although GJ patients had a mean reduction in the number of hospitalization of −1.5 ± 0.5 days, p<0.001, after conversion. Conclusions No differences in preoperative patient characteristics or diagnostic evaluations were seen in GT fed versus GJ converted patients. GJ patients did experience an overall decrease in total admissions after GJ conversion.

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“…40 Enteral tube presence was chosen because of our prior study showing that tube placement increases risk of hospitalization in aspirating patients. 41 Results are presented as effect sizes and 95% CI around the difference in the effect size metric. Statistical analysis was conducted with SAS statistical software (version 9.4, SAS).…”

Section: Key Pointsmentioning

confidence: 99%

Association of Proton Pump Inhibitors With Hospitalization Risk in Children With Oropharyngeal Dysphagia

Duncan

Mitchell

Larson

et al. 2018

JAMA Otolaryngol Head Neck Surg

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IMPORTANCE Proton pump inhibitors (PPI) are commonly prescribed to children with oropharyngeal dysphagia and resultant aspiration based on the assumption that these patients are at greater risk for reflux-related lung disease. There is little data to support this approach and the potential risk for increased infections in children treated with PPI may outweigh any potential benefit. OBJECTIVE The aim of this study was to determine if there is an association between hospitalization risk in pediatric patients with oropharyngeal dysphagia and treatment with PPI. DESIGN, SETTING, AND PARTICIPANTS We performed a retrospective cohort study to compare the frequency and length of hospitalizations for children who had abnormal results on videofluoroscopic swallow studies that were performed between January 1, 2015, and December 31, 2015, and who were or were not treated with PPI, with follow-up through December 31, 2016. Records were reviewed for children who presented for care at Boston Children's Hospital, a tertiary referral center. Participants included 293 children 2 years and younger with evidence of aspiration or penetration on videofluoroscopic swallow study. EXPOSURES Groups were compared based on their exposure to PPI treatment. MAIN OUTCOMES AND MEASURES The primary outcomes were hospital admission rate and hospital admission nights and these were measured as incident rates. Multivariable analyses were performed to determine predictors of hospitalization risk after adjusting for comorbidities. Kaplan-Meier curves were created to determine the association of PPI prescribing with time until first hospitalization. RESULTS A total of 293 patients with a mean (SD) age of 8.8 (0.4) months and a mean (SD) follow-up time of 18.15 (0.20) months were included in the analysis. Patients treated with PPI had higher admission rates (Incidence rate ratio [IRR], 1.77; 95% CI, 1.16-2.68) and admission nights (IRR, 2.51; 95% CI, 1.36-4.62) even after adjustment for comorbidities. Patients with enteral tubes who were prescribed PPIs were at the highest risk for admission (hazard ratio [HR], 2.31; 95% CI, 1.24-4.31). CONCLUSIONS AND RELEVANCE Children with aspiration who are treated with PPI have increased risk of hospitalization compared with untreated patients. These results support growing concern about the risks of PPI use in children.

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Oral Feeding Reduces Hospitalizations Compared with Gastrostomy Feeding in Infants and Children Who Aspirate

Cited by 40 publications

References 30 publications

Respiratory morbidity in Rett syndrome: an observational study

Respiratory morbidity in Rett syndrome: an observational study

Preoperative Evaluation Is Not Predictive of Transpyloric Feeding Conversion in Gastrostomy‐dependent Pediatric Patients

Association of Proton Pump Inhibitors With Hospitalization Risk in Children With Oropharyngeal Dysphagia

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