title: Percutaneous endoscopic gastrostomy tubes in pediatric bone marrow transplant patients.
abstract: OBJECTIVE
  Nourishing a child undergoing bone marrow transplant (BMT) is essential, but the optimal method to achieve this is not established. The objectives of the study were to investigate the incidence and risk factors for complications of gastrostomy tubes in patients with BMT.
  
  
  METHODS
  A retrospective chart review was conducted of pediatric patients who received a percutaneous endoscopic gastrostomy (PEG) either for BMT or for other indications during a 3-year period. Occurrences of complications, absolute neutrophil count (ANC) at time of PEG placement, and ANC at time of complication were reviewed for both BMT and the comparison group.
  
  
  RESULTS
  Of the 11 subjects in the BMT group, 4 (36%) had a major complication of infection related to PEG and 3 of those required PEG removal. Two of the 4 subjects who developed a major complication were moderately neutropenic at the time of PEG placement and all subjects were neutropenic at the time of complication. Of the 30 subjects in the comparison group, only 1 (2.8%) had a major complication with cellulitis. There were no statistically significant differences between the 2 groups before PEG placement for age, weight, albumin, or white blood cell count. The incidence of complication in BMT compared with the comparison group was significant (P=0.01).
  
  
  CONCLUSIONS
  Our findings support that ANC should be considered before placement of PEG, significant neutropenia may be a contraindication for PEG placement in BMT patients, and other modalities for nutrition support might need to be considered.
authors.affiliation: Division of Pediatric Gastroenterology and Nutrition, Mount Sinai School of Medicine, New York, NY 10029, USA.
authors.forename: Sunpreet
authors.initials: S
authors.lastname: Kaur
authors.forename: Clare
authors.initials: C
authors.lastname: Ceballos
authors.forename: Ruijun
authors.initials: R
authors.lastname: Bao
authors.forename: Nanci
authors.initials: N
authors.lastname: Pittman
authors.forename: Keith
authors.initials: K
authors.lastname: Benkov
mesh_terms: D016026:Bone Marrow Transplantation / Q000009:adverse effects*; D002648:Child; D002675:Child, Preschool; D020878:Device Removal; D004750:Enteral Nutrition / Q000009:adverse effects*; D005260:Female; D005500:Follow-Up Studies; D005773:Gastroscopy; D005774:Gastrostomy / Q000009:adverse effects*; D006785:Hospitals, University; D006801:Humans; D015994:Incidence; D007223:Infant; D007239:Infections / Q000453:epidemiology / Q000276:immunology; D008297:Male; D009503:Neutropenia / Q000453:epidemiology / Q000276:immunology; D009519:New York City / Q000453:epidemiology; D011183:Postoperative Complications / Q000453:epidemiology* / Q000276:immunology / Q000601:surgery; D012189:Retrospective Studies; D012307:Risk Factors