Short Bowel Syndrome and Long Duration of Feeding Problems

VJ Christian et al. JPGN 2021; 72: 442-445. Pediatric Feeding Disorder in Children With Short Bowel Syndrome

This small (n=28) retrospective study provides useful information on the persistence of feeding problems in children with short bowel syndrome (SBS). The authors defined a pediatric feeding disorder (PFD) as “reliance on enteral feeds to sustain nutrition, reliance on high-calorie oral supplements to sustain nutrition, or feeding skill dysfunction resulting in not consuming an age-appropriate diet.” Patients who remained on PN were considered to have a PFD as well.

Key findings:

  • Of the 21 patients (75% of total cohort) who were weaned off parenteral nutrition, 57.1%, 81.0%, 90.5%, and 100.0% achieved this by 12, 24, 36, and 48 months of age, respectively. Median age at time of weaning PN was 10.8 months.
  • Of the 13 patients who were weaned off enteral nutrition (EN), 30.8%, 69.2%, 76.9%, and 100.0% achieved this by 12, 24, 36, and 48 months, respectively. Median age of weaning EN was 15.7 months. Overall, about a third of patients required EN beyond 2 years of life.
  • The prevalence of PFD (of entire cohort) was 100.0%, 76.5%, 68.8%, and 70.0% at 1, 2, 3, and 4 years of age, respectively

My take: When parents ask how long it will be before my child is off PN and eating by mouth, this study’s results could be useful.

Chicago at Sunrise

Related blog posts for Short Bowel Syndrome:

Nutrition Symposium Georgia AAP (Part 3)

Along with Kylia Crane, I presented the final lecture at this year’s Georgia AAP Nutrition Symposium: Optimizing Nutrition and Formula Selection in Toddler’s and Children.  Kylia is a nutritionist and dietician at the Georgia AAP who works on a multitude of projects to enhance nutrition for pediatric patients across the state.  This lecture was intended as a practical review of feeding problems and poor growth.

After a brief discussion of some basic feeding principles, the lecture focused on specific case presentations and then reviewed formula selection.  At the end, I quickly mentioned some of the big nutrition stories for 2015. The entire talk will be available at the Nutrition4Kids website.

Here are some of the slides:

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Additional resources that I discussed:

FeedingTubeAwareness.com

—Ellyn Satter:

  • —“Child of Mine”
  • —“The Secrets of Feeding a Healthy Family”

—Laura Jana/Jennifer Shu:

  • —“Food Fights”

In the lecture, I credited some of the material to Dr. Praveen Goday who shared his slides from a previous lecture.  In addition, I am grateful to Dr. Seth Marcus who provided input into the lecture content.

Related blog posts:

 

 

Chronic Care Mode: GJ tube Data

A lot has changed in the field of pediatric gastroenterology since I completed my training 16 years ago.  One technology that is used frequently now is the gastrojejunal (GJ) tube for feeding neurologically-impaired children.  Previously, GJ tubes were used as a temporary solution.  Part of the rational for short-term usage was that these tubes were often difficult to maintain; they could easily become dislodged or clogged.

A recent study documents the more frequent usage of GJ tubes and their indefinite usage to treat complex feeding issues (JPGN 2013; 56: 523-27).

This retrospective chart review encompassed a 10 year period (1999-2009) at a single academic center.  In total 33 patients were treated with GJ tubes with 160 placements.  The mean age at initial placement was 6 years and the mean weight 19.4 kg. 76% of the patients had cerebral palsy/neurologic disorder, 21% had congenital heart disease, and 9% had chronic lung disease.

Common indications for replacement: dislodgment, obstruction, coiling into stomach, and broken tubing.

Three techniques were used:

  1. Fluoroscopy with guide wire and subsequent GJ
  2. Gastroduodenscopy via gastrostomy site to place guidewire for GJ placement
  3. Tube placement during esophagogastroduodenoscopy

Most procedures (85%) did not require sedation.

Outcomes:

  • 13 (39%) maintained on GJ throughout study period
  • 10 (30%) converted to gastric or oral feeds
  • 5 (15%) surgical intervention
  • 5 (15%) deceased
  • Duration of tube survival: mean 91 days for Mic-Key GJ (low profile) and 177 days for  coaxial PEG-PEJ (e.g. 16 French Corflo gastric tube with 6 French jejunal tube)

When reading the study, it is hard to ignore Figure 3 which shows more than 30 placements per year after 2007 whereas the number was about two per year before 2001. In the discussion, the authors do not focus on how this technology has been embraced so widely.  It is mostly a discussion on the indications, methods, and complications.  Indications included high aspiration risk, intractable vomiting, failed Nissen fundoplication, and gastroparesis.  “Our study showed that long-term jejunal feeding via GJ tubes is possible and safe.”

My preference is generally to avoid GJ feedings as a primary intervention for long-term feeding problems.  That is, when patients need gastrostomy tube feeds but are prone to vomiting, most often a fundoplication is worthwhile.  When a patient has had a fundoplication that is no longer effective, a GJ tube should be considered.

Related blog links: