Impact of fundoplication versus gastrojejunal feeding tubes on mortality and in preventing aspiration pneumonia in young children with neurologic impairment who have gastroesophageal reflux disease.
OBJECTIVE
Aspiration pneumonia is the most common cause of death in children with neurologic impairment who have gastroesophageal reflux disease. Fundoplications and gastrojejunal feeding tubes are frequently employed to prevent aspiration pneumonia in this population. Which of these approaches is more effective in preventing aspiration pneumonia and/or improving survival is unknown. The objective of this study was to compare outcomes for children with neurologic impairment and gastroesophageal reflux disease after either a first fundoplication or a first gastrojejunal feeding tube.


METHODS
This was a retrospective, observational cohort study of children with neurologic impairment who had either a fundoplication or gastrojejunal feeding tube between January 1997 and December 2005 at a tertiary care children's hospital. Main outcome measures were postprocedure aspiration pneumonia-free survival and mortality. Propensity analyses were used to control for bias in treatment assignment and prognostic imbalances.


RESULTS
Of the 366 children with neurologic impairment and gastroesophageal reflux disease, 43 had a first gastrojejunal feeding tube and 323 underwent a first fundoplication. Median length of follow-up was 3.4 years. Children who received a first fundoplication had similar rates of aspiration pneumonia and mortality after the procedure compared with those who had a first gastrojejunal feeding tube, when adjusting for the treatment assignment using propensity scores.


CONCLUSIONS
Aspiration pneumonia and mortality are not uncommon events after either a first fundoplication or a first gastrojejunal feeding tube for the management of gastroesophageal reflux disease in children with neurologic impairment. Neither treatment option is clearly superior in preventing the subsequent aspiration pneumonia or improving overall survival for these children. This complex clinical scenario needs to be studied in a prospective, multicenter, randomized control trial to evaluate definitively whether 1 of these 2 management options is more beneficial.
Srivastava
Rajendu
R
University of Utah Health Sciences Center, Division of Inpatient Medicine, Salt Lake City, UT 84113, USA. raj.srivastava@hsc.utah.edu
Downey
Earl C
EC
O'Gorman
Molly
M
Feola
Peter
P
Samore
Matthew
M
Holubkov
Richard
R
Mundorff
Michael
M
James
Brent C
BC
Rosenbaum
Peter
P
Young
Paul C
PC
Dean
Jonathan M
JM
D002675:Child, Preschool; D015331:Cohort Studies; D004750:Enteral Nutrition / Q000379:methods / Q000401:mortality*; D005260:Female; D005500:Follow-Up Studies; D018662:Fundoplication / Q000379:methods / Q000401:mortality*; D005764:Gastroesophageal Reflux / Q000150:complications / Q000401:mortality* / Q000601:surgery; D006801:Humans; D007223:Infant; D008297:Male; D009422:Nervous System Diseases / Q000150:complications / Q000401:mortality* / Q000601:surgery; D011015:Pneumonia, Aspiration / Q000401:mortality* / Q000517:prevention & control* / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate / Q000639:trends