Abstract
Early feeding after percutaneous endoscopic gastrostomy (PEG) placement is an accepted practice in the treatment of adult patients and the knowledge is clinically extrapolated in the treatment of children. To verify this treatment in children—as there are some specific features of PEG-related practices in children—the present study aimed to review meta-analyses of early feeding (within 4 h) after PEG placement in children. We searched the PubMed database for articles published until July 2020. A quality assessment was performed using the Grading of Recommendations, Assessment, Development, and Evaluation method. Three randomized controlled trials (208 patients) were eligible for inclusion. No patients died within 72 h. Early feeding resulted in little to no difference in the length of hospital stay (mean difference [MD] −7.47, 95% confidence interval [CI] −25.16 to 10.21; I2 = 95%) and vomiting events (risk ratio 0.84, 95% CI 0.55 to 1.31; I2 = 0%). In a subgroup analysis, early feeding without antibiotics reduced the length of hospital stay in one study (MD −21.60, 95% CI −22.86 to −20.34) but early feeding with antibiotics did not affect the length in two studies (MD 0.28, 95% CI −6.49 to 7.06; I2 = 0%). Overall, the certainty of the evidence was not very high. In summary, early feeding after PEG placement may be a safe alternative to delayed feeding in children. The findings in children seemed similar to those in adults, while there is a need for further studies that specifically investigate PEG placement-related practices in children.
Highlights
Childhood is a dynamic period of growth and development [1,2]
They should know some differences in the indications of percutaneous endoscopic gastrostomy (PEG) between adults and children, and in the associated complications and prognosis; for instance, PEG placement is often indicated for cerebrovascular disease and malignancy
The results of the present review of three random controlled trials (RCTs) [19,20,26] revealed that early feeding within 4 h after PEG placement in child patients had little to no effect on mortality, hospital stay, or vomiting events in comparison to delayed feeding
Summary
Childhood is a dynamic period of growth and development [1,2]. Eating disorders, dysphagia, and failure to thrive can lead to malnutrition [1,2]. In consideration of health maintenance and/or disease management, percutaneous endoscopic gastrostomy (PEG) is a method to provide nutrition into the stomach through the abdominal wall for patients who have a functioning gastrointestinal tract but who are unable to eat sufficiently [3]. More understanding of PEG for children is necessary among patients, caregivers, and medical staff [6,7]. They should know some differences in the indications of PEG between adults and children, and in the associated complications and prognosis; for instance, PEG placement is often indicated for cerebrovascular disease and malignancy. In adults [8], while it is commonly indicated for neurological and neuromuscular disorders in children [9,10,11]
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