Mortality After Feeding Tube Placement in Children with Neurologic Impairment

A population-based study (KE Nelson et al. Pediatrics 2019; 143: e20182863) used an administrative data based from Ontario, Canada to examine the mortality rates among children with a diagnosis of neurologic impairment who underwent either gastrostomy placement or gastrojejunal placement between 1993-2015.

Key findings:

  • Two-year survival after feeding tube placement was 87.4% and 5-year survival was 75.8%
  • Unplanned hospital days, emergency room visits and outpatient visits were not significantly different after tube placement compared to pre-tube placement.

The authors interpret their findings as showing a high mortality which is likely due to medical fragility as there was “stability of health care use before and after the procedure.”

In the associated commentary (by KJ Lee and TE Corden, e20183623) the authors note the placement of a Gtube often took place after an increase in health care in the weeks prior.  They recommended engaging in shared-decision making regarding Gtube placement prior to crisis.

My take: There have been a number of studies, particularly in adults, that have shown that Gtubes may not prolong survival in many conditions.  However, they have been shown to improve nutritional status, simplify care, and improve quality of life.

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