Abstract
Feeding difficulties are common in children with cerebral palsy (CP). The goal of this study was to examine pediatric CP patients undergoing gastrostomy tube (G tube) placement and assess the association between patient characteristics and weight after 3 months, 6 months, and 1 year. This was a retrospective study of all pediatric patients with CP who received a G tube placement between April 2014 and December 2017 at a single institution. Bivariate analysis was used to examine association between patient characteristics and the primary outcome of improvement in weight Z score at 3, 6, and 12 months. Of 63 patients who received a G tube, 81% had an increase in Z score at 3 months, 44% at 6 months, and 64% at 12 months. By 12 months, factors associated with a positive Z score change included moderate and severe malnutrition, lack of prior G tube, and fewer comorbidities. The majority (69.8%) of patients experienced complications. Seven (11%) patients died, with only 1 death related to G tube placement. The use of G tubes in CP patients resulted in an increase in an improvement in nutritional status for the majority of patients over the course of a year. Although most complications were minor, patients had a high complication rate and frequently visited the emergency department, highlighting the need for standardized education and follow-up among this patient population.
Highlights
The use of gastrostomy tubes in children with cerebral palsy leads to increased weight gain over 1 year, with patients who are moderately to severely malnourished, who have not had prior gastrostomy tubes, and who have few comorbid conditions benefitting from the most substantial weight gain
gastrostomy tube (G tube) feeding was associated with increases in weight gain over time in cerebral palsy (CP) patients.[1,6,14,15,16,23,25]
We noted that patient characteristics associated with improved Z score changes varied over the 3, 6, and 12 months post-gastrostomy placement period
Summary
Cerebral palsy (CP) represents a group of disorders with deficits primarily in motor function with an incidence of 2 per 1000 live births.[1,2,3,4] Children with CP are at increased risk of developing malnutrition secondary to oral motor and oropharyngeal dysfunction, hypotonia, motility disorders, as well as poor posture due to unstable trunks, leading to feeding difficulties.[5,6,7]Malnutrition, defined as a severe lack of nutrients resulting in decreased body function, affects multiple organ systems and can lead to significant morbidity, mortality, and failure to thrive in this population.[8,9,10,11,12,13]The American Surgeon 0(0)Studies looking at the use of gastrostomy tubes (G tubes) in children with CP have shown that they lead to increased weight gain.[6,14,15,16] studies have shown that there are complications associated with G tubes, with reported complication rates ranging from 4 to 26%.17-19 Some of these complications are minor, such as dislodgement, leakage, and cellulitis, while others can be more serious, such as bleeding, abscesses, peritonitis, organ injury, and even death.[10,20,21]. Studies looking at the use of gastrostomy tubes (G tubes) in children with CP have shown that they lead to increased weight gain.[6,14,15,16] studies have shown that there are complications associated with G tubes, with reported complication rates ranging from 4 to 26%.17-19. Some of these complications are minor, such as dislodgement, leakage, and cellulitis, while others can be more serious, such as bleeding, abscesses, peritonitis, organ injury, and even death.[10,20,21]. The goal of this study was to examine pediatric CP patients undergoing gastrostomy tube (G tube) placement and assess the association between patient characteristics and weight after 3 months, 6 months, and 1 year
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