Effectiveness of Fundoplication or Gastrojejunal Feeding in Children With Neurologic Impairment. - PubMed - NCBI

Effectiveness of Fundoplication or Gastrojejunal Feeding in Children With Neurologic Impairment. - PubMed - NCBI

Hosp Pediatr. 2017 Mar;7(3):140-148. doi: 10.1542/hpeds.2016-0126. Epub 2017 Feb 3

Effectiveness of Fundoplication or Gastrojejunal Feeding in Children With Neurologic Impairment.

Stone B1, Hester G2, Jackson D3, Richardson T4, Hall M4, Gouripeddi R5, Butcher R5, Keren R6, Srivastava R3,7.

Author information

Abstract

BACKGROUND AND OBJECTIVES:

Gastroesophageal reflux (GER), aspiration, and secondary complications lead to morbidity and mortality in children with neurologic impairment (NI), dysphagia, and gastrostomy feeding. Fundoplication and gastrojejunal (GJ) feeding can reduce risk. We compared GJ to fundoplication using first-year postprocedure reflux-related hospitalization (RRH) rates.

METHODS:

We identified children with NI, dysphagia requiring gastrostomy tube feeding and GER undergoing initial GJ placement or fundoplication from January 1, 2007 to December 31, 2012. Data came from the Pediatric Health Information Systems augmented by laboratory, microbiology, and radiology results. GJ placement was ascertained using radiology results and fundoplication by International Classification of Diseases, Ninth Revision, Clinical Modification codes. Subjects were matched within hospital using propensity scores. The primary outcome was first-year postprocedure RRH rate (hospitalization for GER disease, other esophagitis, aspiration pneumonia, other pneumonia, asthma, or mechanical ventilation). Secondary outcomes included failure to thrive, death, repeated initial intervention, crossover intervention, and procedural complications.

RESULTS:

We identified 1178 children with fundoplication and 163 with GJ placement, matching 114 per group. Matched sample RRH incident rate per child-year (95% confidence interval) for GJ was 2.07 (1.62-2.64) and for fundoplication 1.67 (1.28-2.18), P = .19. Odds of death were similar between groups. Failure to thrive, repeat of initial intervention, and crossover intervention were more common in the GJ group.

CONCLUSIONS:

In children with NI, GER, and dysphagia: fundoplication and GJ feeding have similar RRH outcomes. Either intervention can reduce future aspiration risk; the choice can reflect non-RRH-related complication risks, caregiver preference, and clinician recommendation.

Copyright © 2017 by the American Academy of Pediatrics.

PMID:

 

28159744

 

DOI:

 

10.1542/hpeds.2016-0126

[Indexed for MEDLINE] 

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