title: Timing of gastrostomy insertion in children with a neurodisability: a cross-sectional study of early versus late intervention.
abstract: OBJECTIVE
  The aim of the study was to assess whether gastrostomy placement before 18 months of age results in a greater increase in z-score for weight and to assess whether admission rates were reduced postgastrostomy in this age group.
  
  
  METHODS
  Retrospective cross-sectional study.
  
  
  METHODS
  Single-centre secondary care District General Hospital.
  
  
  METHODS
  All children with a neurodisability with a gastrostomy in situ in September 2011 were included. Those with primary neoplasia and undergoing chemo or radiotherapy or being palliated for an aggressive neurodegenerative disorder were excluded. Those with cystic fibrosis, primary congenital heart disease or Inflammatory bowel disease were also excluded. Forty-one children underwent final analysis. Twenty-four children underwent gastrostomy insertion less than 18 months and 17 children were older than 18 months.
  
  
  METHODS
  Primary outcome was z-scores for weight immediately pregastrostomy and 12 months postgastrostomy. Secondary outcomes were hospital admission rates pregastrostomy and postgastrostomy. Values were compared for those with gastrostomy insertion less than or equal to 18 months against those older than 18 months at insertion.
  
  
  RESULTS
  Z-score for weight increased significantly in both age groups. There was significantly increased mean difference in the z-score for weight of +1.33 pregastrostomy and postgastrostomy in the less than 18 months age group as compared with an increased mean difference in the z-score for weight of +0.45 in the older age group (p=0.021). There was no significant difference in the admission rates postgastrostomy insertion in either age group.
  
  
  CONCLUSIONS
  Gastrostomy insertion before 18 months of age results in greater z-score for weight gain in children with a neurodisability. This conclusion is limited by the lack of height and skin-fold thickness measurements. Further long-term matched control studies are required to determine the neurodevelopmental and clinical benefit of early gastrostomy placement in such children.
authors.affiliation: Department of Paediatrics,  Virtual Academic Unit, Child Development Centre, Northampton, Northants,  UK.
authors.forename: Raman
authors.initials: R
authors.lastname: Sharma
authors.forename: Andrew N
authors.initials: AN
authors.lastname: Williams
authors.forename: Win
authors.initials: W
authors.lastname: Zaw