Abstract
IntroductionA gastrostomy placement (GP) is an established treatment to provide enteral feeding in pediatric patients with feeding difficulties aiming to improve nutritional status and health-related quality of life (HRQoL). The aim of this study was to evaluate HRQoL in children with severe feeding difficulties who have undergone GP.Materials and methodsA cross-sectional study was performed including 128 patients who had undergone laparoscopic GP (2004–2011). HRQoL was evaluated using the validated Pediatric Quality of Life 4.0 Inventory. Multiple regression analysis was performed to identify predictors of HRQoL.ResultsAfter a mean follow-up of 4.0 years (interquartile range 2.9–6.2) after GP, mean HRQoL was 53.0 out of 100 (standard deviation 21.1). HRQoL was significantly lower in children with neurologic impairment, with a mean difference of −21.4 points between neurologically impaired and neurologically normal children (p < 0.001). HRQoL was also lower in children with cardiac disease (−19.0 points; p = 0.01) and in children with a history of previous gastrointestinal surgery (−15.2 points; p = 0.03). Feeding through a gastrojejunostomy tube (−33.0 points; p = 0.01) and higher age at the time of operation (−1.2 points per year; p = 0.03) were also associated with lower HRQoL. GP-related complications requiring reintervention were associated with lower HRQoL, although this association was not statistically significant (p = 0.06).ConclusionsChildren with severe feeding difficulty, who have undergone GP, have significantly lower HRQoL compared to a healthy pediatric population. Neurologic impairment, cardiac disease, a history of gastrointestinal surgery, older age, and the need for jejunal feeding through the gastrostomy were predictive of even lower HRQoL.
Highlights
A gastrostomy placement (GP) is an established treatment to provide enteral feeding in pediatric patients with feeding difficulties aiming to improve nutritional status and health-related quality of life (HRQoL)
We found that after a mean follow-up time of 4.0 years (IQR 2.9–6.2), children with a gastrostomy had significantly lower HRQoL compared to the HRQoL of a large population of healthy normal children
Our findings are in line with findings of another study by Varni et al reporting on HRQoL assessment in 2500 children among 33 different disease categories
Summary
A gastrostomy placement (GP) is an effective treatment to provide enteral tube feeding in children in need of nutritional support. [1, 2] Previous studies on GP in children have focused primarily on the physical outcomes of patients after operation [3]. Health-related quality of life (HRQoL) is increasingly recognized as an essential component of patient care outcomes. It aims to assess the impact of an illness and its treatment on the dimensions of physical, psychological, and social health [4,5,6,7,8]. Where the aforementioned studies did not use validated HRQoL questionnaires, in this study the Pediatric Quality of Life (PedsQLTM) 4.0 Generic Core Scales were used. This is a reliable and valid tool for proxy-report of HRQoL by caregivers and a parallel self-report for children. The aim of our study was to evaluate HRQoL in children with severe feeding difficulty who have been treated with GP and to identify predictors (both patient characteristics and gastrostomyrelated factors) of HRQoL
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