title: Tolerance and efficacy of preventive gastrostomy feeding in pediatric oncology.
abstract: BACKGROUND
  Malnutrition in pediatric oncology remains underestimated, although having a negative impact on outcome. Enteral nutrition (EN) using percutaneous endoscopic gastrostomy (PEG) may prevent or reverse malnutrition consequences. We aimed to evaluate both efficacy and safety of early EN during tumors treatment in children.
  
  
  METHODS
  Medical records of pediatric patients having a PEG tube inserted between 1995 and 2009 were retrospectively reviewed. We compared type and incidence of complications in Group 1, including 74 patients suffering from cancer, and control Group 2, including 57 patients with neurological impairment. Efficacy of EN was evaluated through nutritional parameters [Z-scores weight for height (W/H) and height for age (H/A)], post-operative complications and relapse rates. Statistical significance was set for P < 0.05.
  
  
  RESULTS
  PEG tolerance was similar in both groups, as shown by comparable complication rates (62% vs. 76%, NS). EN allowed improvement or stabilization of Z-score W/H in 76% of oncologic patients. The final height loss was lower (-0.5 vs. -1.2 SD of Z-scores H/A) when EN was started at the beginning of the oncologic treatment. In bone tumors, EN prevented weight loss during chemotherapy, and tended to lessen surgical complications, relapses and deaths.
  
  
  CONCLUSIONS
  Early gastrostomy feeding represents a relatively safe way to prevent malnutrition in children with cancer, and might play a role in bone tumors oncological outcome. Further prospective studies are needed to confirm these results and assess the impact of EN and PEG on quality of life.
authors.affiliation: Department of Pediatric Surgery, Mother and Child Hospital, Nantes University Hospital, Nantes, France. francoise.schmitt@etu.univ-nantes.fr
authors.forename: Françoise
authors.initials: F
authors.lastname: Schmitt
authors.forename: Dominique
authors.initials: D
authors.lastname: Caldari
authors.forename: Nadège
authors.initials: N
authors.lastname: Corradini
authors.forename: Philippe
authors.initials: P
authors.lastname: Gicquel
authors.forename: Patrick
authors.initials: P
authors.lastname: Lutz
authors.forename: Marc-David
authors.initials: MD
authors.lastname: Leclair
authors.forename: Guillaume
authors.initials: G
authors.lastname: Podevin
mesh_terms: D000293:Adolescent; D002648:Child; D015362:Child Nutrition Disorders / Q000209:etiology* / Q000517:prevention & control*; D002675:Child, Preschool; D004750:Enteral Nutrition / Q000379:methods*; D005260:Female; D005774:Gastrostomy; D006801:Humans; D007223:Infant; D007228:Infant Nutrition Disorders / Q000209:etiology* / Q000517:prevention & control*; D008297:Male; D009369:Neoplasms / Q000150:complications* / Q000628:therapy; D012189:Retrospective Studies