title: Factors affecting clinical outcome in gastrostomy-fed children with cystic fibrosis.
abstract: In order to assess the effects of gastrostomy feeding on nutritional status, respiratory function, and survival in children with cystic fibrosis (CF), we studied all patients undergoing gastrostomy between 1989-1997 at the Royal Children's Hospital, Melbourne. Clinical information was collected from medical records, including serial measurements of weight-for-age standard deviation scores (WAZ) and forced expired volume in 1 sec (FEV1) (percent predicted). Measurements were compared for 2 years before and 2 years after gastrostomy placement. Data on gastroesophageal reflux (GER), adherence to the gastrostomy feeding program, and sputum culture were also assessed. Of 37 children (22 male; mean age, 11.6 +/- 4.8 years; range, 3-20), 11 died during the study period (7 female, 4 male). Female patients were more likely to die within 2 years of gastrostomy placement (OR = 3.9; 95% CI, 0.72-23.2; P = 0.07). Mortality was significantly associated with a WAZ score < -2 (OR = 10.7; 95% CI, 1.07-466.6; P = 0.02) and predicted FEV1 < 50% (OR = 10.8; 95% CI, 1.07-512.9; P = 0.02) at time of gastrostomy. Patients with clinical evidence of GER (n = 11) had significantly lower weight gain after gastrostomy (delta WAZ, -0.32 +/- 0.26 vs. 0.03 +/- 0.39; P = 0.03). In conclusion, the presence of advanced lung disease, GER, and female gender were factors associated with a poor clinical outcome after gastrostomy placement.
authors.affiliation: Department of Gastroenterology and Nutrition, Royal Children's Hospital, Melbourne, Australia. mark.oliver@rch.org.au
authors.forename: Mark R
authors.initials: MR
authors.lastname: Oliver
authors.forename: Ralf G
authors.initials: RG
authors.lastname: Heine
authors.forename: Chi Hang
authors.initials: CH
authors.lastname: Ng
authors.forename: Evelyn
authors.initials: E
authors.lastname: Volders
authors.forename: Anthony
authors.initials: A
authors.lastname: Olinsky
mesh_terms: D000293:Adolescent; D000328:Adult; D001835:Body Weight / Q000502:physiology; D002648:Child; D002675:Child, Preschool; D003550:Cystic Fibrosis / Q000401:mortality* / Q000503:physiopathology / Q000628:therapy*; D004750:Enteral Nutrition; D005260:Female; D005541:Forced Expiratory Volume / Q000502:physiology; D005764:Gastroesophageal Reflux / Q000503:physiopathology; D005774:Gastrostomy; D006801:Humans; D008297:Male; D017063:Outcome Assessment, Health Care; D011237:Predictive Value of Tests; D012189:Retrospective Studies; D012737:Sex Factors