Gastrostomy Tubes Placed in Children With Neurologic Impairment: Associated Morbidity and Mortality
| Autor: | Jody L. Lin, Douglas K Owens, Keith Van Haren, MyMy C. Buu, Jay Bhattacharya, Joseph Rigdon, Olga Saynina, Lee M. Sanders |
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| Rok vydání: | 2021 |
| Předmět: |
Male
Pediatrics medicine.medical_specialty Adolescent California Cohort Studies 03 medical and health sciences Young Adult 0302 clinical medicine 030225 pediatrics medicine Humans 030212 general & internal medicine Child Feeding tube Intubation Gastrointestinal Proportional Hazards Models Retrospective Studies Gastrostomy business.industry Infant medicine.disease Dysphagia Pneumonia Gastrostomy tube Child Preschool Pediatrics Perinatology and Child Health Female Neurology (clinical) medicine.symptom Morbidity Nervous System Diseases business |
| Zdroj: | Journal of child neurology. 36(9) |
| ISSN: | 1708-8283 |
| Popis: | Background: Gastrostomy tube (G-tube) placement for children with neurologic impairment with dysphagia has been suggested for pneumonia prevention. However, prior studies demonstrated an association between G-tube placement and increased risk of pneumonia. We evaluate the association between timing of G-tube placement and death or severe pneumonia in children with neurologic impairment. Methods: We included all children enrolled in California Children’s Services between July 1, 2009, and June 30, 2014, with neurologic impairment and 1 pneumonia hospitalization. Prior to analysis, children with new G-tubes and those without were 1:2 propensity score matched on sociodemographics, medical complexity, and severity of index hospitalization. We used a time-varying Cox proportional hazard model for subsequent death or composite outcome of death or severe pneumonia to compare those with new G-tubes vs those without, adjusting for covariates described above. Results: A total of 2490 children met eligibility criteria, of whom 219 (9%) died and 789 (32%) had severe pneumonia. Compared to children without G-tubes, children with new G-tubes had decreased risk of death (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.39-0.55) but increased risk of the composite outcome (HR 1.21, CI 1.14-1.27). Sensitivity analyses using varied time criteria for definitions of G-tube and outcome found that more recent G-tube placement had greater associated risk reduction for death but increased risk of severe pneumonia. Conclusion: Recent G-tube placement is associated with reduced risk of death but increased risk of severe pneumonia. Decisions to place G-tubes for pulmonary indications in children with neurologic impairment should weigh the impact of severe pneumonia on quality of life. |
| Databáze: | OpenAIRE |
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