title: Gastrostomy feeding in infants and children on peritoneal dialysis.
abstract: The majority of infants and young children on peritoneal dialysis (PD) require enteral feeding to achieve their growth potential. We report our experience of gastrostomy feeding in 29 children on PD over 11 years. Fifteen children, median age 3.9 (0.5-13.3) years had a percutaneous gastrostomy (PEG) or Nissen fundoplication and gastrostomy (N and G) or open gastrostomy (OG) before starting PD (group1). Nine children, age 0.7 (0.5-12.4) years, had a N and G or OG (group 2) and 5, age 5.1 (1-15.1) years, a PEG (group 3) after PD catheter insertion/start of PD. In group 1 (257 months gastrostomy feeding with PD), there were 0.6 episodes of peritonitis/patient year. Nine PEGs were replaced electively after 27 (19-50) months, with bleeding from an embedded flange the only complication. One PEG replaced by a button ruptured the track, causing Candida peritonitis. In group 2 (130 months G and PD), there were 1.4 episodes of peritonitis/patient year. Two children developed paraoesophageal hernias, which were successfully repaired. Four children in group 3 developed peritonitis soon after PEG placement. Two transferred to haemodialysis, 1 remained on PD after treatment of Candida peritonitis and 1 subsequently died. Only 2 of the 17 children who have had renal transplants still need gastrostomy feeds. We recommend placement of a PEG or OG if an anti-reflux procedure is necessary prior to starting PD. Placement of a PEG while on PD is contraindicated, but an OG is a safe alternative procedure.
authors.affiliation: Renal Unit, Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UK. leders@gosh.nhs.uk
authors.forename: Sarah E
authors.initials: SE
authors.lastname: Ledermann
authors.forename: Lewis
authors.initials: L
authors.lastname: Spitz
authors.forename: Jeane
authors.initials: J
authors.lastname: Moloney
authors.forename: Lesley
authors.initials: L
authors.lastname: Rees
authors.forename: Richard S
authors.initials: RS
authors.lastname: Trompeter
mesh_terms: D001424:Bacterial Infections; D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition; D005260:Female; D018662:Fundoplication; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods; D006801:Humans; D007223:Infant; D007676:Kidney Failure, Chronic / Q000628:therapy*; D016030:Kidney Transplantation; D008297:Male; D010530:Peritoneal Dialysis / Q000009:adverse effects; D010538:Peritonitis / Q000209:etiology / Q000382:microbiology; D012189:Retrospective Studies