Gastrostomy feeding in cerebral palsy: a systematic review.
OBJECTIVE
To determine benefits and risks for gastrostomy or jejunostomy feeding compared with oral feeding for children with cerebral palsy.


METHODS
Systematic review.


METHODS
electronic databases--Cochrane Library, Medline, Embase, Cinahl, Lilacs, databases of theses, grey literature. INCLUDED: relevant systematic reviews, randomised controlled trials, observational studies, case reports. EXCLUDED: non-systematic reviews and qualitative research.


METHODS
children with cerebral palsy.


METHODS
use of gastrostomy or jejunostomy tube to provide nutrition.


RESULTS
evaluated outcome measures included death, growth, gastro-oesophageal reflux, other complications, psychosocial aspects, and caregiver wellbeing.


RESULTS
No relevant systematic reviews or randomised controlled trials were found. Two cohort studies, 15 case series, and eight case reports met the inclusion criteria. Eight studies specifically described percutaneous endoscopic gastrostomy as the intervention. Weight gain resulted from gastrostomy feeding in most cases. There was an approximately fourfold increased risk of death reported in one cohort study for the gastrostomy fed children. Many complications were reported, including potential for increased gastro-oesophageal reflux and fluid aspiration into the lungs.


CONCLUSIONS
Benefits associated with gastrostomy or jejunostomy feeding are difficult to assess from the available evidence. Risks of gastrostomy, particularly in relation to surgical complications, have been described but the size of the risk could not be quantified. The finding of a higher death rate for children fed by gastrostomy may merely reflect the greater disability of these compared with orally fed children. Lack of available evidence and the substantial risk of bias in observational studies suggests that a well conducted randomised controlled trial of sufficient size will be needed to answer these problems.
Sleigh
G
G
National Perinatal Epidemiology Unit, Institute of Health Sciences, Old Road, Headington, Oxford OX3 7LF, UK. gilliannicholls@ntlworld.com
Brocklehurst
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D002547:Cerebral Palsy / Q000150:complications*; D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition / Q000009:adverse effects / Q000379:methods*; D001068:Feeding and Eating Disorders / Q000209:etiology / Q000628:therapy*; D005774:Gastrostomy / Q000009:adverse effects / Q000379:methods*; D006801:Humans; D007223:Infant; D007582:Jejunostomy / Q000009:adverse effects; D016032:Randomized Controlled Trials as Topic