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Effect of Gastrojejunal Feedings on Visits and Costs in Children With Neurologic Impairment

King, Marta*; Barnhart, Douglas C.; O’Gorman, Molly; Downey, Earl C.; Jackson, Daniel; Mundorff, Michael§; Holubkov, Richard; Feola, Peter; Srivastava, Rajendu

Journal of Pediatric Gastroenterology & Nutrition: April 2014 - Volume 58 - Issue 4 - p 518–524
doi: 10.1097/MPG.0000000000000227
Original Articles: Gastroenterology

Objective: The objective of the present study was to determine the effect of gastrojejunal tube (GJT) feedings in children with neurologic impairment (NI) on gastroesophageal reflux disease (GERD)– and/or dysfunctional swallowing–related visits and their associated costs.

Methods: The present study is a retrospective cohort study of children with NI and GERD who underwent GJT placement at the study hospital from December 1999 to October 2006. Visits (emergency department, radiology, and hospitalizations) were reviewed from the time of birth until 1 year following GJT placement and classified as either not GERD and/or dysfunctional swallowing related or GERD and/or dysfunctional swallowing related (eg, pneumonias). Incident rate ratios (IRRs) were calculated by dividing the post-GJT visit rate by the pre-GJT visit rate. Other outcomes included associated costs, fundoplications, and deaths.

Results: Thirty-three patients met inclusion criteria. The IRR for total visits was 1.78 (95% confidence interval [CI] 1.12–2.81) and for GERD- and/or dysfunctional swallowing–related visits 2.88 (95% CI 1.68–4.94). Feeding tube-related visits (IRR 5.36, 95% CI 2.73–10.51) accounted for the majority. GERD- and/or dysfunctional swallowing–related costs per child per year were low overall, with no difference from pre-GJT versus post-GJT placement ($1851 vs $4601, P = 0.89). Seven (21%) children underwent Nissen fundoplication and 4 (12%) died within 1 year of GJT placement. Two deaths involved jejunal perforation.

Conclusions: Children with NI and GERD who are treated with GJT feedings have significantly more GERD- and/or dysfunctional swallowing–related visits in the following year. The majority of these visits are because of the procedural complications, which are inexpensive. There is, however, mortality associated with the GJT and some children proceed to a fundoplication.

*Department of Pediatrics, Saint Louis University School of Medicine, Cardinal Glennon Hospital, St Louis, MO

Department of Pediatrics, Primary Children's Hospital

Department of Pediatric Surgery, University of Utah

§Systems Improvement, Primary Children's Hospital, Intermountain Health Care Inc, Salt Lake City, UT.

Address correspondence and reprint requests to Rajendu Srivastava, MD, MPH, Primary Children's Hospital, 100N Mario Capecchi Drive, Salt Lake City, UT 84113 (e-mail: raj.srivastava@hsc.utah.edu).

Received 27 December, 2012

Accepted 22 October, 2013

R.S. is the recipient of a grant from the Eunice Kennedy Shriver National Institute for Child Health and Human Development at the National Institutes of Health, career development award K23 HD052553, and this project was supported in part by the Child Health Research Center at the University of Utah and Primary Children's Hospital Foundation.

The authors report no conflicts of interest.

© 2014 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,