Effects of Gastrostomy Feeding in Children With Cerebral Palsy: An AACPDM Evidence Report
Developmental Medicine & Child Neurology
Samson-Fang, L., Butler, C., et al. (2003).
Developmental Medicine & Child Neurology, 45(6), 415-426.
This systematic review investigates the effects of gastrostomy feeding (e.g., percutaneous endoscopic gastrostomy, jejunostomy, gastrojejunostomy) on a variety of outcomes in children, younger than 18-years-old, with cerebral palsy.
American Academy for Cerebral Palsy and Developmental Medicine
Through 2002
Published, English-language studies (not further specified)
10
Positive effects on caregiver satisfaction and family stress [from tube feeding] were reported for most but not all participants. Some families (11/39) in one study reported an increase in stress following gastrostomy due to more limited access to respite care, reduced mobility of the child, and change in caregiver-child relationship.
Most participants reported that tube feeding resulted in improvement in ease of feeding, time spent in feeding, and stress of feeding.
Although the findings from the included studies "indicate that children have a rapid response to nutritional support regardless of age" (p. 423) minimum growth standards were met more often in children treated before the effects of malnutrition became established (i.e., children treated earlier and younger).
Gastrostomy yielded positive effects for most participants in outcomes of growth (e.g., weight, height, weight for height), nutritional status (e.g., fat stores), failure to thrive, and reflux. Mixed or unchanged results post-gastrostomy were reported for outcomes related to aspiration, caloric adequacy, nutrient intake adequacy, and osteopenia.
The review was comprised of studies with low levels of evidence and a very limited sampling of the population. "The strongest factor lending credibility to this body of evidence is the consistency of results in favor of gastrostomy. However, the uniformity of results shows that there was a minority of individuals who did not improve" (p. 425).
The published data on types and rates of complications secondary to gastrostomy are limited due to the study designs employed and non-standardized reporting. Therefore, few conclusions can be drawn. Included studies reported death rates of 14%-26%. Reported rates of major complications ranged from 17%-39%. Minor complication rates were reportedly high (84%).
