Gastrostomy Tubes Placed in Children With Neurologic Impairment: Associated Morbidity and Mortality. (August 2021)

• Record Type: Journal Article
• Authors: Lin, Jody L.; Rigdon, Joseph; Van Haren, Keith; Buu, MyMy; Saynina, Olga; Bhattacharya, Jay; Owens, Douglas K.; Sanders, Lee M.
• Is Part Of: Journal of child neurology. Volume 36:Number 9(2021)
• Page Start: 727
• Page End: 734
• Publication Date: 2021-08
• Subjects: neurologic impairment -- pneumonia -- feeding tube -- evidence-based medicine; Nervous system -- Diseases -- Periodicals; 618.928
• DOI: 10.1177/08830738211000179
• Languages: English
• ISSNs: 0883-0738

Abstract

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.