1546 Jejunal tube feeding in children: safety and efficacy

Abstract

<h3>Background</h3> Over the last decade, transpyloric devices have become a readily available alternative for patients who do not benefit from having their feeds delivered through gastric ports. At our institution, there is an increasing demand for jejunal tube feeding (JTF) due to the increasing prevalence of children with neurological impairment and significant co-morbidities. <h3>Objectives</h3> We aimed to evaluate the safety of JTF and its efficacy at maintaining adequate weight gain in patients reliant on JTF. <h3>Methods</h3> A retrospective review of patients who underwent JTF between January 2014 and February 2021 was performed. Data collected included demographics, co-morbidities, indications for JTF, complications and mortality. The number and nature of complications, together with the mean weight Z-score change after JTF initiation, were used as an outcome measure. Institutional approval was received for this study. <h3>Results</h3> A total of 32 patients were reviewed. They had a total of 230 jejunal tubes placed (mean of 7.2). Of the cohort, 20 were male (62.5%). The median age was 16.6 months (6.1–169.5) at JTF initiation. Neurological impairment was found in 62.5% of patients; 80% of which was cerebral palsy. The most common indications for JTF were gastro-oesophageal reflux disease and vomiting (83.9% and 77.4%, respectively). Associated indications were a combination of dysphagia, aerodigestive birth defects and faltering growth despite gastric feeding, either by gastrostomy or nasogastric tube. There were a total of 98 complications in 230 jejunal tubes. Of these, 88 were minor with dislodgment (36%) being the most common. Major complications (10) were identified among 8 patients: buried bumper (n=2), bowel ischemia (n=2), bowel perforation (n=2), upper GI bleed (n=2), peritonitis (n=1) and volvulus (n=1), of whom 2 required bowel resections. Two patients who were initiated on JTF underwent subsequent fundoplication. One mortality was noted in relation to co-morbidities rather than the feeding tube itself. The median device replacement interval was 5.1 months (1.8–11.4) and the median length of stay was 6.4 days (0 – 289). At JTF initiation, the mean weight Z-score was −1.82±1.42 (−4.41–1.10). The follow-up weight Z-scores could be reached in a different number of patients at each study time point (table 1). <h3>Conclusions</h3> JTF exposes patients to a relatively high risk of complications. At our institution, the vast majority were minor in nature (89.8%). The need for repeated admissions and the possibility of major complications should influence parental discussions and informed consent before the initiation of JTF. Significant improvement to weight Z-scores could be seen at 1 month after the initiation of transpyloric feeds and was maintained at 3 years. We conclude that this form of enteral nutrition can be a moderately safe and efficacious method of feed delivery.