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The Use of Jejunal Tube Feeding in Children

A Position Paper by the Gastroenterology and Nutrition Committees of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition 2019

Broekaert, Ilse*; Falconer, Jackie; Bronsky, Jiri; Gottrand, Frederic§; Dall’Oglio, Luigi||; Goto, Eunic; Hojsak, Iva#; Hulst, Jessie**; Kochavi, Brigitte††; Papadopoulou, Alexandra‡‡; Ribes-Koninckx, Carmen§§; Schaeppi, Michela||||; Werlin, Steven¶¶; Wilschanski, Michael##; Thapar, Nikhil***

Journal of Pediatric Gastroenterology and Nutrition: May 6, 2019 - Volume Publish Ahead of Print - Issue - p
doi: 10.1097/MPG.0000000000002379
Societal Paper: PDF Only
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Objectives: Jejunal tube feeding (JTF) is increasingly becoming the standard of care for children where gastric tube feeding is insufficient to achieve caloric needs. Given a lack of a systematic approach to the care of JTF in paediatric patients, the aim of this position paper is to provide expert guidance regarding the indications for its use and practical considerations to optimise its utility and safety.

Methods: A group of members of the Gastroenterology and Nutrition Committees of the European Society of Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) and of invited experts in the field was formed in September 2016 to produce this clinical guide. Seventeen clinical questions treating indications and contraindications, investigations prior to placement, techniques of placement, suitable feeds and feeding regimen, weaning from JTF, complications, long-term care, and ethical considerations were addressed.

A systematic literature search was performed from 1982 to November 2018 using Pubmed, the MEDLINE and Cochrane Database of Systematic Reviews. Grading of Recommendations, Assessment, Development, and Evaluation was applied to evaluate the outcomes.

During a consensus meeting, all recommendations were discussed and finalized. In the absence of evidence from randomized controlled trials, recommendations reflect the expert opinion of the authors.

Results: A total of 33 recommendations were voted on using the nominal voting technique.

Conclusions: JTF is a safe and effective means of enteral feeding when gastric feeding is insufficient to meet caloric needs or is not possible. The decision to place a jejunal tube has to be made by close cooperation of a multidisciplinary team (MDT) providing active follow-up and care.

*University Children's Hospital, University of Cologne, Faculty of Medicine, Cologne, Germany

Paediatric Gastroenterology and Nutrition unit, Chelsea and Westminster Hospital, Fulham, London, UK

Department of Paediatrics, University Hospital Motol, Prague, Czech Republic

§Department of Paediatric Gastroenterology, Hepatology and Nutrition, CHU Lille, University Lille, Lille, France

||Digestive Endoscopy and Surgical Unit, Bambino Gesù Children's Hospital, Rome, Italy

Paediatric Gastroenterology and Nutrition unit, Chelsea and Westminster Hospital, Fulham, London, UK

#Children's Hospital Zagreb, University of Zagreb School of Medicine, Zagreb, University J.J. Strossmayer, School of Medicine, Osijek, Croatia

**Department of Paediatric Gastroenterology, Erasmus Medical Centre – Sophia Children's Hospital, Rotterdam, the Netherlands

††Pediatric Gastroenterology Unit, The Edmond and Lily Safra Children's Hospital, The Haim Sheba Medical Center, Ramat Gan, Israel

‡‡Division of Gastroenterology, Hepatology and Nutrition, First Department of Pediatrics, University of Athens, Children's Hospital “Agia Sofia”, Athens, Greece

§§Pediatric Gastroenterolgy, Hepatology and Nutrition, La Fe University Hospital, Valencia, Spain

||||Pediatric Gastroenterology, Grangettes Clinic, Geneva, Switzerland

¶¶The Medical College of Wisconsin, Milwaukee, WI, USA

##Pediatric Gastroenterology Unit, Hadassah – Hebrew University Medical Center, Jerusalem, Israel

***Neurogastroenterology and Motility Unit, Department of Pediatric Gastroenterology, Great Ormond Street Hospital NHS Foundation Trust, London, UK.

Address correspondence and reprint requests to Ilse Broekaert, MD, and Nikhil Thapar, University Children's Hospital Cologne, Cologne, Germany (e-mail: ibroekaert@gmail.com, n.thapar@ucl.ac.uk)

Received 7 January, 2019

Accepted 25 April, 2019

Ilse Broekaert and Jackie Falconer shared first co-authorship.

The authors report no conflicts of interest.

© 2019 by European Society for Pediatric Gastroenterology, Hepatology, and Nutrition and North American Society for Pediatric Gastroenterology,