Do gastrostomies prevent hospitalizations?

Abstract

Children with intellectual disability frequently undergo gastrostomy in order to continue enteral feeds. Indications for gastrostomy include failure to thrive, dysphagia and pulmonary aspiration, or even oral aversion. These children often have complex, comorbid conditions, such as cerebral palsy, seizures, or cardiopulmonary dysfunction. Parents are thus often challenged by the decision whether to proceed with gastrostomy, as a feeding tube will change daily care and long-term outcome for their child. Do gastrostomies help keep children out of the hospital? In this volume of The Journal, Jacoby et al use retrospective databases from 2 Australian states to examine the frequency of hospital admissions before and after gastrostomy insertion in children with severe intellectual disability. The incidence of all-cause and epilepsy hospitalizations declined years after the procedure, but not hospitalizations specific to acute lower respiratory tract infection. Fundoplication did appear to lower the relative incidence of acute lower respiratory tract infection admissions. Overall, gastrostomy was associated with some health benefits, but was not a failsafe to prevent hospitalizations from respiratory illnesses. Children with intellectual disability are still often susceptible to aspiration of their own secretions and that could explain the lack of benefit. Other changes in the delivery of overall care following the procedure might also influence positively or negatively the chance of a child being hospitalized. This study makes clear that gastrostomy is not a panacea for feeding the child with severe intellectual disability, and indeed a management decision for which families and providers must carefully weigh risks and benefits and also consider family values. Article page 131 ▸ Risk of Hospitalizations Following Gastrostomy in Children with Intellectual DisabilityThe Journal of PediatricsVol. 217PreviewTo examine the frequency of hospital admissions before and after gastrostomy insertion in children with severe intellectual disability. Full-Text PDF