Study provides data on outcomes after feeding tube placement in children with neurologic impairment

Children with neurologic impairment often receive feeding tubes to improve nutrition or to reduce oral aspiration from swallowing dysfunction. While feeding tubes provide benefits to patients, they also present potential risks of harm. Only a few, small studies have examined longer term outcomes.

Neurologic impairment comprises a broad group of diagnoses, including cerebral palsy and specific genetic or metabolic conditions, which cause problems in cognitive and physical function.

A team led by researchers at The Hospital for Sick Children (SickKids) and ICES analyzed survival rates after feeding tube placement in children between 13 months and 17 years of age. They also examined their use of the health-care system.

Their analysis determined that rates of acute health-care utilization did not increase in the two years following tube placement compared to the two years before tube placement. Emergency room visits and outpatient visits did not increase significantly from before and after the feeding tube placement. The data showed that 23 per cent of children with neurological impairment died within five years of feeding tube placement.

“Our findings that health-care use did not increase or decrease significantly can help families anticipate the effects of feeding tube placement. Though mortality is high, our study did not suggest that tube placement is the cause,” says Dr. Nelson, Staff Physician, Paediatric Advanced Care Team at SickKids. “Patients with a feeding tube likely have underlying fragility, which could contribute to the rate of mortality. If the feeding tube was the cause, we would have expected to see an increase in health-care use after tube placement.”

The results of this study are important for decision-making conversations with families to help them understand how the tube placement will affect their child. SickKids is launching a new Gastrostomy Tube Feeding Program on February 11 with the goal of improving outcomes for children who undergo feeding tube placement. “This program will bring together experts from across the hospital including staff from Nursing, Pediatrics, Gastroenterology, General Surgery, Image Guided Therapy, and Dietetics to work with parents to optimize quality of care,” says Dr. Mahant, Staff Physician, Division of Paediatric Medicine at SickKids and the Medical Director of the Gastrostomy Tube Feeding Program.

In this population-based study, the team looked at the data from 948 children with neurologic impairment who underwent primary feeding tube placement, either a gastrostomy or gastrojejunostomy tube, between 1993 and 2015 at 24 Ontario hospitals. The team compared the patients’ acute health-care utilization during the two years before and after feeding tube placement.

The full findings are published in the Jan. 24 online edition of Pediatrics.

The team who conducted this study included:

• Dr. Katherine Nelson, Staff Physician, Paediatric Advanced Care Team at SickKids
• Dr. Sanjay Mahant, Staff Physician, Division of Paediatric Medicine at SickKids and Associate Scientist, Child Health Evaluative Sciences (CHES) program
• Dr. Laura Rosella, Associate Professor, Epidemiology at the University of Toronto, Senior Scientist, ICES
• Dr. Eyal Cohen, Staff Physician, Division of Paediatric Medicine and Associate Scientist and Program Head , CHES at SickKids
• Dr. Astrid Guttmann, Staff Physician, Division of Paediatric Medicine, Senior Associate Scientist at CHES at SickKids and Chief Science Officer at ICES

This study was funded by the Norman Saunders Complex Care Initiative and supported by ICES, which is funded by an annual grant from the Ontario Ministry of Health and Long-Term Care (MOHLTC). This is an example of how SickKids is making Ontario healthier, wealthier and smarter (www.healthierwealthiersmarter.com).