J. Jadi1,2, N. Rodriguez-Ormaza3, R. Maine1, A. Charles1, E. Hoke1, T. Reid1 1University Of North Carolina At Chapel Hill,General And Acute Care Surgery,Chapel Hill, NC, USA 2University Of North Carolina At Chapel Hill,School Of Medicine,Chapel Hill, NC, USA 3University Of North Carolina At Chapel Hill,School Of Public Health,Chapel Hill, NC, USA
Introduction: Malnutrition as a result of feeding difficulties is a common complication in children with cerebral palsy. There are currently few studies looking at interventions for malnutrition and which ones have the best growth outcomes for pediatric cerebral palsy patients. The goal of this study was to examine characteristics of cerebral palsy patients undergoing gastrostomy tube placement and assess the growth outcomes after 3 months, 6 months, and 1 year.
Methods: This study was a retrospective study of all pediatric patients with cerebral palsy under the age of 18 who received a gastrostomy tube placement between April 2014-December 2017 at UNC Hospital. Baseline information was collected, including age, sex, degree of malnutrition, comorbidities, change in weight and z scores over time, nasogastric (NG) tube placement, and prior gastrostomy tube placement. The primary outcome was weight gain at 3 months, 6 months, and 1 year. Secondary outcomes included mortality and complications. Bivariate analysis and a proportional odds model were used to examine the association between increase in weight (based on quantiles) and patient characteristics at 3 months, 6 months, and 1 year.
Results: Out of the 63 patients who received a gastrostomy tube, 30 (47.6%) were female, with a mean age of 4.3 months +/- 4.9. Almost all patients (98.8%) had at least one comorbidity. At the time of placement, 11.8% of patients had mild malnutrition, 29.4% had moderate malnutrition, and 58.8% had severe malnutrition. A majority of 53 (94.6%) patients had their tube placed laparoscopically, while the rest were placed open. Greater increases in weight at all time intervals were significantly associated with younger age, adjunct NG tube, and longer length of hospital stay after adjusting for confounders. Patients weight changes tracked at 3 months, 6 months, and 1-year post gastrostomy placement showed an overall weight increase for 98% of patients. Forty-six percent of patients had at least one gastrostomy tube related complication, 23.8% had two complications, and 4.76% had 3 or more with the most common complications being minor tube functional issues (43.6%), such as clogging, leakage, or tube dislodgment.
Conclusion: The use of gastrostomy tubes for malnutrition in cerebral palsy patients resulted in an increase in weight for the majority of patients over the course of a year. Although the majority of complications were minor, patients had a high complication rate. Given the high complication rate and the significantly increased weight gain in younger patients who were hospitalized longer and who had NG tubes, further studies should be conducted to evaluate if certain patients might benefit from longer trials of NG tube nutrition.
