Factors Associated With Success and Failure of Weaning Children From Prolonged Enteral Nutrition: A Retrospective Cohort Study. Issue 1 (January 2021)

• Record Type: Journal Article
• Authors: Dipasquale, Valeria; Lecoeur, Katia; Aumar, Madeleine; Guimber, Dominique; Coopman, Stéphanie; Nicolas, Audrey; Turck, Dominique; Gottrand, Frédéric; Ley, Delphine
• Is Part Of: Journal of pediatric gastroenterology and nutrition. Volume 72:Issue 1(2021)
• Publication Date: 2021-01
• Subjects: outcome -- outpatient -- pediatrics -- tube feeding -- weaning; Children -- Nutrition -- Periodicals; Pediatric gastroenterology -- Periodicals; Infants -- Nutrition -- Periodicals; Nutrition disorders in children -- Periodicals; Child Nutrition -- Periodicals; Digestive System -- growth & development -- Periodicals; Gastrointestinal Diseases -- Periodicals; Infant Nutrition -- Periodicals; Nutrition Disorders -- Periodicals; Child; 618.923
• DOI: 10.1097/MPG.0000000000002909
• Languages: English
• ISSNs: 0277-2116

Abstract

ABSTRACT: Objectives: The aims of the present study were to assess the efficacy of a tube weaning program, and to identify factors associated with success and failure. Methods: This was a retrospective cohort study including all pediatric patients on enteral nutrition (EN) for ≥6 months for whom at least 1 attempt of weaning was performed in a single tertiary referral center from 2012 to 2017, with a minimum follow-up of 6 months after EN discontinuation. Weaning program was individualized to each child. Weaning success was defined a priori. Factors associated with success were investigated using multivariate analysis. Results: Ninety-four patients were enrolled, in whom a total of 114 attempts of weaning were performed at a median age of 51 ± 40 months. Success was achieved in 80 attempts (success rate of 70%). One hundred three (92%) weaning attempts were performed at home with a follow-up in the outpatient clinic, mostly (74%) by a progressive (>1 month) reduction of tube feeding. Patients who required psychological support during weaning had more failures than patients who did not (odds ratio = 5.7, 95% confidence interval [1.2–27.0], P = 0.03). The presence of impaired oral feeding skills at the time of EN discontinuation was also predictive of failure (odds ratio = 6.2, 95% confidence interval [0.05–0.5], P = 0.005). Conclusions: Our progressive, mostly outpatient-based, patient-tailored program of weaning from EN is effective for tube-dependent children. Children who need psychological support during weaning and those who present impaired oral feeding skills represent a subgroup of at-risk patients for whom alternative weaning strategies may need to be considered. Abstract : Supplemental Digital Content is available in the text