title: Effect of gastrojejunal feedings on visits and costs in children with neurologic impairment.
abstract: OBJECTIVE
  The objective of the present study was to determine the effect of gastrojejunal tube (GJT) feedings in children with neurologic impairment (NI) on gastroesophageal reflux disease (GERD)- and/or dysfunctional swallowing-related visits and their associated costs.
  
  
  METHODS
  The present study is a retrospective cohort study of children with NI and GERD who underwent GJT placement at the study hospital from December 1999 to October 2006. Visits (emergency department, radiology, and hospitalizations) were reviewed from the time of birth until 1 year following GJT placement and classified as either not GERD and/or dysfunctional swallowing related or GERD and/or dysfunctional swallowing related (eg, pneumonias). Incident rate ratios (IRRs) were calculated by dividing the post-GJT visit rate by the pre-GJT visit rate. Other outcomes included associated costs, fundoplications, and deaths.
  
  
  RESULTS
  Thirty-three patients met inclusion criteria. The IRR for total visits was 1.78 (95% confidence interval [CI] 1.12-2.81) and for GERD- and/or dysfunctional swallowing-related visits 2.88 (95% CI 1.68-4.94). Feeding tube-related visits (IRR 5.36, 95% CI 2.73-10.51) accounted for the majority. GERD- and/or dysfunctional swallowing-related costs per child per year were low overall, with no difference from pre-GJT versus post-GJT placement ($1851 vs $4601, P = 0.89). Seven (21%) children underwent Nissen fundoplication and 4 (12%) died within 1 year of GJT placement. Two deaths involved jejunal perforation.
  
  
  CONCLUSIONS
  Children with NI and GERD who are treated with GJT feedings have significantly more GERD- and/or dysfunctional swallowing-related visits in the following year. The majority of these visits are because of the procedural complications, which are inexpensive. There is, however, mortality associated with the GJT and some children proceed to a fundoplication.
authors.affiliation: *Department of Pediatrics, Saint Louis University School of Medicine, Cardinal Glennon Hospital, St Louis, MO †Department of Pediatrics, Primary Children's Hospital ‡Department of Pediatric Surgery, University of Utah §Systems Improvement, Primary Children's Hospital, Intermountain Health Care Inc, Salt Lake City, UT.
authors.forename: Marta
authors.initials: M
authors.lastname: King
authors.forename: Douglas C
authors.initials: DC
authors.lastname: Barnhart
authors.forename: Molly
authors.initials: M
authors.lastname: O'Gorman
authors.forename: Earl C
authors.initials: EC
authors.lastname: Downey
authors.forename: Daniel
authors.initials: D
authors.lastname: Jackson
authors.forename: Michael
authors.initials: M
authors.lastname: Mundorff
authors.forename: Richard
authors.initials: R
authors.lastname: Holubkov
authors.forename: Peter
authors.initials: P
authors.lastname: Feola
authors.forename: Rajendu
authors.initials: R
authors.lastname: Srivastava
mesh_terms: D002675:Child, Preschool; D003680:Deglutition Disorders / Q000191:economics / Q000209:etiology / Q000628:therapy*; D004750:Enteral Nutrition / Q000191:economics* / Q000379:methods; D004868:Equipment Failure / Q000191:economics; D005260:Female; D018662:Fundoplication; D005764:Gastroesophageal Reflux / Q000191:economics / Q000209:etiology / Q000628:therapy*; D006801:Humans; D007223:Infant; D007416:Intestinal Perforation / Q000209:etiology; D007441:Intubation, Gastrointestinal / Q000009:adverse effects* / Q000191:economics*; D007579:Jejunal Diseases / Q000209:etiology; D008297:Male; D009422:Nervous System Diseases / Q000150:complications; D009819:Office Visits / Q000191:economics / Q000706:statistics & numerical data*; D012189:Retrospective Studies