Tube feeding and quality of life in children with severe neurological impairment.
OBJECTIVE
To assess the quality of life (QOL) of neurologically impaired children before and after gastrostomy (G) and gastrojejunostomy (GJ) tube insertion.


METHODS
This was a prospective longitudinal study of children with severe neurological impairment who underwent G or GJ tube insertion. At baseline, and at 6 and 12 months after tube insertion, parents rated (1) global QOL and health-related quality of life (HRQOL) using 10 cm visual analogue scales, with 10 representing maximal QOL and (2) HR-QOL using a questionnaire-based measure.


RESULTS
Fifty patients, 45 and five of whom underwent G and GJ tube insertion, respectively, were enrolled with a median age of 591 days. Forty-two had a static neurological disorder, and eight had a progressive neurological disorder. The mean weight for age z score increased significantly over time: -2.8 at baseline and -1.8 at 12 months. The mean QOL and HR-QOL scores at baseline were 5.5 and 5.6 out of 10, respectively. There was no significant change in these scores at 6 and 12 months post-tube insertion. Children with a progressive versus a static neurological disorder had a significantly lower QOL over time. Ease of medication administration as well as feeding showed a significant improvement in scores from baseline to 12 months. Parents felt that the G and GJ tube had a positive impact on their child's health at 6 months (86%) and 12 months (84%).


CONCLUSIONS
QOL as rated by parents did not increase following insertion of a G or GJ tube in neurologically impaired children. However, parents felt that the tube had a positive impact on their child's health, particularly with regards to feeding and administration of medications.
Mahant
S
S
Division of Pediatric Medicine, The Hospital for Sick Children, Toronto, Canada. sanjay.mahant@sickkids.ca
Friedman
J N
JN
Connolly
B
B
Goia
C
C
Macarthur
C
C
D000293:Adolescent; D002547:Cerebral Palsy / Q000178:diet therapy* / Q000523:psychology; D002648:Child; D002675:Child, Preschool; D004750:Enteral Nutrition; D005500:Follow-Up Studies; D006304:Health Status; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D019636:Neurodegenerative Diseases / Q000178:diet therapy* / Q000523:psychology; D009752:Nutritional Status; D011446:Prospective Studies; D011788:Quality of Life; D016896:Treatment Outcome; D015430:Weight Gain