Safety and Efficacy of Bedside Percutaneous Endoscopic Gastrostomy Placement in the Neonatal Intensive Care Unit

Abstract

Bedside PEG placement is safe with minimal complications. It is associated with little need for ventilator support and allows for early re-initiation of feeds and early success at reaching goal feedings.

Percutaneous endoscopic gastrostomy in small infants unable to swallow safely

“…We also believe that PEGs should always be placed under general anesthesia with endotracheal intubation in infants to prevent tracheal compression by the endoscope or the PEG tube itself. Endotracheal intubation seems to be one of the essential prerequisites in small infants even when a “bedside” PEG placement is preferred in a neonatal intensive care unit 4 . The PEG tubes used in the present series do not have inner bolsters and they basically look like self‐retaining Malecot catheters.…”

“…Endotracheal intubation seems to be one of the essential prerequisites in small infants even when a "bedside" PEG placement is preferred in a neonatal intensive care unit. 4 The PEG tubes used in the present series do not have inner bolsters and they basically look like self-retaining Malecot catheters. Regardless of the weight of the child, we always prefer to use this sort of collapsible PEG tube because we believe that the potential risk of esophageal injury while the tube is pulled from the mouth down through the esophagus is thus minimalized.…”

“…The most common indication for PEG placement in children is providing safe intragastric nutritional support and thus avoiding the risks of aspiration due to unsafe swallowing. [3][4][5][6][7] The European Society for Paediatric Gastroenterology Hepatology and Nutrition's (ESPGHAN) 2015 position paper states the indication for PEG solely as follows: "nutritional support via gastrostomy is indicated in children requiring prolonged enteral tube feeding." 8 There is no limitation as to the amount of time that should pass before PEG insertion is attempted if the expertise and the infrastructure required to insert a PEG are sufficient in a center.…”

“…Although Gauderer's very first patient who underwent PEG placement was a fourand-half month old baby, the published data focusing on the small infant population is minimal. 1,[3][4][5] Most pediatric studies include older children with a mixed population in terms of age and weight. We aimed to evaluate the safety of PEG placement in infants weighing ≤5 kg together with their follow-up results to add further to the medical data about this group of patients.…”

“…Percutaneous endoscopic gastrostomy tubes are preferred over nasogastric or orogastric tubes in the long term, especially if the infant is going to be discharged from the hospital. Although Gauderer’s very first patient who underwent PEG placement was a four‐and‐half month old baby, the published data focusing on the small infant population is minimal 1,3–5 . Most pediatric studies include older children with a mixed population in terms of age and weight.…”