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

McSweeney, Maireade E.; Kerr, Jessica; Amirault, Janine; Fishman, Eliza; Lurie, Margot; Peinado-Fabregat, Maria I.; Mitchell, Paul D.; Rosen, Rachel

doi:10.1097/mpg.0000000000001866

Cited by 4 publications

(4 citation statements)

References 24 publications

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“…A review of results of preoperative evaluation done at the time of GT insertion found that no specific diagnostic test reliably predicted whether patients remained on GT feeding or required conversion to JT feeding. However, this was a retrospective study with incomplete data and further prospective research is needed to help understand the value and role of diagnostic evaluation prior to enteral feeding 21 …”

Section: Recommendations and Discussionmentioning

confidence: 99%

“…However, this was a retrospective study with incomplete data and further prospective research is needed to help understand the value and role of diagnostic evaluation prior to enteral feeding. 21 Contraindications to JT feeding are not specifically discussed in detail in the literature; however, some studies describe local experience and practices. General contraindications to enteral feeding should apply to JT feeding, with vigilance advised in the presence of active gastrointestinal bleeding and/or high stool/ stoma output.…”

Section: Journal Of Parenteral and Enteral Nutritionmentioning

confidence: 99%

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A clinical consensus paper on jejunal tube feeding in children

McGrath,

Collins,

Comerford

et al. 2024

J Parenter Enteral Nutr

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BackgroundFeeding problems are common in children with complex medical problems or acute critical illness and enteral nutrition may be required. In certain situations, gastric tube feeding is poorly tolerated or may not be feasible. When feed intolerance persists despite appropriate adjustments to oral and gastric enteral regimens, jejunal tube feeding can be considered as an option for nutrition support.MethodsA multidisciplinary expert working group of the Australasian Society of Parenteral and Enteral Nutrition was convened. They identified topic questions and five key areas of jejunal tube feeding in children. Literatures searches were undertaken on Pubmed, Embase, and Medline for all relevant studies, between January 2000 and September 2022 (n = 103). Studies were assessed using National Health and Medical Research Council guidelines to generate statements, which were discussed as a group, followed by voting on statements using a modified Delphi process to determine consensus.ResultsA total of 24 consensus statements were created for five key areas: patient selection, type and selection of feeding tube, complications, clinical use of jejunal tubes, follow‐up, and reassessment.ConclusionJejunal tube feeding is a safe and effective means of providing nutrition in a select group of pediatric patients with complex medical needs, who are unable to be fed by gastric tube feeding. Appropriate patient selection is important as complications associated with jejunal tube feeding are not uncommon, and although mostly minor, can be significant or require tube reinsertion. All children receiving jejunal tube feeding should have multidisciplinary team assessment and follow‐up.

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Section: Recommendations and Discussionmentioning

confidence: 99%

Section: Journal Of Parenteral and Enteral Nutritionmentioning

confidence: 99%

A clinical consensus paper on jejunal tube feeding in children

McGrath,

Collins,

Comerford

et al. 2024

J Parenter Enteral Nutr

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“…Of note, the rates of postoperative transition to postpyloric (gastrojejunostomy) feeding was higher with our transition to LAP gastrostomy tubes. We had previously reported in a retrospective review of 158 patients undergoing PEG placement and found no well defined patient factors or diagnostic testing for predicting, which patients may go onto require a transition to postpyloric feeding (30). Therefore, we hypothesize that some of this increased rate of gastrojejunal tube placement after LAP procedure, may simply be because of provider's ability to more easily exchange to a gastrojejunostomy tube sooner, because of the increased stability of having a sutured stoma tract, versus the PEG procedure, which requires adherance of the stomach mucosa to the abdominal wall Shown are N (%) or mean AE SD as unweighted as well as weighted by the inverse probability of treatment weight (IPTW).…”

Section: Discussionmentioning

confidence: 99%

A Retrospective Review of Primary Percutaneous Endoscopic Gastrostomy and Laparoscopic Gastrostomy Tube Placement

McSweeney

Mitchell

Smithers

et al. 2021

J. pediatr. gastroenterol. nutr.

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Objectives:The laparoscopic-assisted gastrostomy tube placement (LAP) has increasingly become the preferred method for placing gastrostomy tubes in infants and children. The goal of this retrospective review was to examine our institutional experiences with our transition from the percutaneous endoscopic gastrostomy (PEG) procedure to LAP technique.Methods:All patients undergoing primary PEG or LAP gastrostomy at Boston Children's Hospital between January 2010 and June 2015 were identified. The primary aim was to compare complication rates within the first 6 months after tube placement; differences in total hospital procedural costs, hospital resource utilization, and postoperative gastroesophageal reflux disease were examined.Results:Nine hundred and eighty-seven patients (442 PEG and 545 LAP gastrostomy tubes) were included. No differences in total complications within 6 months were seen. Patients undergoing PEG placement had more gastrostomy-related complications (PEG 30 [6.7%] vs LAP 13 [2.4%], P = 0.0007) and cellulitis (PEG 23 [5.1%] vs LAP 2 [0.4%], P = 0.03) within the first week of placement. Patients undergoing LAP procedures had more granulation tissue episodes (PEG 19 [4.4%] vs LAP 107 [19.8%], P = 0.005). No differences in emergency room visits, hospital readmissions, or postoperative gastroesophageal reflux disease were seen, although transition to a gastrojejunal tube was higher in patients undergoing LAP procedure (PEG 20 patients [4.6%] vs LAP 51 patients [9.5%], P = 0.0008).Conclusions:Total complications were similar between patients undergoing PEG versus LAP gastrostomy tube placement. Patients with the PEG procedure had more complications within the first week of placement versus patients with the LAP procedure had more granulation skin complications.

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“…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 ). Fundoplication is associated with post-operative complications in up to 59%.…”

Section: Risk Factors For Respiratory Illnessmentioning

confidence: 99%

Evaluation and Management of Respiratory Illness in Children With Cerebral Palsy

et al. 2020

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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.

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

Cited by 4 publications

References 24 publications

A clinical consensus paper on jejunal tube feeding in children

A clinical consensus paper on jejunal tube feeding in children

A Retrospective Review of Primary Percutaneous Endoscopic Gastrostomy and Laparoscopic Gastrostomy Tube Placement

Evaluation and Management of Respiratory Illness in Children With Cerebral Palsy

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