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BAPEN symposium: “original communications”
OC-077 Jejunal tube feeding experience in paediatric nutrition support
  1. C E Paxton1,
  2. P M Gillett1,
  3. G Wilkinson2,
  4. F D Munro3,
  5. S McGurk2,
  6. K Armstrong1,
  7. L Bremner1,
  8. V Robb1,
  9. J E Livingstone1,
  10. D A Devadason1,
  11. D J Mitchell1,
  12. D C Wilson4
  1. 1Department of Paediatric Gastroenterology and Nutrition, NHS Lothian, UK
  2. 2Department of Paediatric Radiology, NHS Lothian, UK
  3. 3Department of Paediatric Surgery, NHS Lothian, UK
  4. 4Child Life and Health, University of Edinburgh, Edinburgh, UK

Abstract

Introduction There is an emerging group of children in whom poor and worsening upper GI dysmotility limits feed toleration and impacts growth; we wished to evaluate the role of jejunal tube feeding (JTF) in this group.

Methods A retrospective cohort study (database/clinical note review) in a tertiary paediatric centre to evaluate use of PEG-J, transgastric gastrojejunostomy (GJ) tubes and surgical roux-en Y jejunostomy (ReYJ), and the impact on growth of JTF in children with worsening GI dysmotility. All children (<18 years) receiving home enteral tube feeding (HETF) during the period 01 January 2002–31 December 2011. Weight at time of commencing JTF and at 6 or 12 months post-start was collected and expressed as SD or Z-score. Change in weight Z-score was calculated using paired t-test.

Results A total of 866 children received HETF during the study period, of whom 41(5%) had JTF at home. Median (range) decimal age at start of JTF was 2.7(0.1–16.2) years. 36 of 41 (88%) had an underlying neurodisability; 33 of 41 (80%) were gastrostomy fed prior to commencing JTF. Of the 41 JTF children, 19 (46%) were fed via a GJ tube, 5 (12%) via PEG-J and 17 (42%) had a ReYJ. The majority of JTF related complications occurred with GJ tubes; although usually minor, one death occurred following small bowel intussusception around a GJ tube. Minor JTF complications included burst balloons, holes in the Y-port or tube and fungal infection and resolution required tube changes. Tube migration was a problem with both GJ and PEG-J tubes; ReYJ were associated with the fewest minor complications of stomal infection and leakage. By study end, 21 (51%) continue on JTF, 9 (22%) died (all but 1 due to their underlying condition), 1 (2%) moved out of area, 2 (5%) transitioned to adult services and 8 (20%) returned to gastric feeding. 25 of 41 children had JTF for >6 months and had longitudinal growth data collected; median (range) weight Z-score at the start of JTF was −1.3 (−5.2–2.1) and rose to −1.0 (−3.4–2.3) by 6–12 months, with a significant improvement in mean (95% CI) change in weight Z-score of 0.7 (0.1 to 1.3) (p=0.02).

Conclusion There are time consuming practical challenges associated with JTF, some of which are device dependent, and ReY JTF appears best for long-term usage. JTF is an effective intervention to improve growth in children with severe and worsening upper GI dysmotility.

Competing interests None declared.

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