title: Medical, surgical, and health outcomes of gastrostomy feeding.
abstract: A prospective controlled study with repeated measures before and after surgery examined the medical, surgical, and health outcomes of gastrostomy for children with disabilities at a tertiary paediatric referral centre in the North Thames area, UK. Anthropometric measures included weight, mid-upper-arm and head circumference. Five-day prospective food diaries were completed and data on physical health and surgical outcomes recorded. Seventy-six children participated and underwent gastrostomy (44 males, 32 females; median age 3 y 4 mo, range 4 mo-17 y 5 mo), and 35/76 required an anti-reflux procedure. Categories of disability were: cerebral palsy (32/76), syndrome of chromosomal or other genetic origin (25/76), slowly progressive degenerative disease (11/76), and unconfirmed diagnosis (8/76). Most children had gross motor difficulties (99%) and were non-ambulant (83%). Oromotor problems were identified in 78% of children, 69% aspirated, and 65% were fed nasogastrically before surgery. The mean weight before surgery was -2.84 standard deviation score (SDS; SD 2.21, range -9.8 to 3.4). Two-thirds of children achieved catch-up growth postoperatively: weight-for-age (mean difference 0.51 SDS, 95% CI 0.23-0.79, p=0.001) and mid-upper arm circumference (mean difference 1.12 cm, 95% confidence interval 0.50-1.75, p=0.001). Health gains included a reduction in drooling, secretions, vomiting, and constipation. Major surgical complications were found in 13/74 children. The study provides evidence that catch-up growth and health gains are possible following gastrostomy.
authors.affiliation: Institute of Child Health and Great Ormond Street Hospital for Children NHS Trust, University College London, UK. gill.craig.1@city.ac.uk
authors.forename: G M
authors.initials: GM
authors.lastname: Craig
authors.forename: L J
authors.initials: LJ
authors.lastname: Carr
authors.forename: H
authors.initials: H
authors.lastname: Cass
authors.forename: R P
authors.initials: RP
authors.lastname: Hastings
authors.forename: M
authors.initials: M
authors.lastname: Lawson
authors.forename: S
authors.initials: S
authors.lastname: Reilly
authors.forename: M
authors.initials: M
authors.lastname: Ryan
authors.forename: J
authors.initials: J
authors.lastname: Townsend
authors.forename: L
authors.initials: L
authors.lastname: Spitz
mesh_terms: D000293:Adolescent; D000886:Anthropometry; D002648:Child; D002675:Child, Preschool; D003072:Cognition Disorders / Q000453:epidemiology*; D015930:Diet Records; D019988:Children with Disabilities; D005260:Female; D005774:Gastrostomy / Q000706:statistics & numerical data*; D006304:Health Status; D006801:Humans; D007223:Infant; D008297:Male; D019957:Motor Skills Disorders / Q000453:epidemiology*; D009752:Nutritional Status; D011183:Postoperative Complications / Q000453:epidemiology*; D011446:Prospective Studies; D011584:Psychology