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McGrath KH, Collins T, Comerford A, McCallum Z, Comito M, Herbison K, Cochrane OR, Burgess DM, Kane S, Coster K, Cooper M, Jesson K. A clinical consensus paper on jejunal tube feeding in children. JPEN J Parenter Enteral Nutr 2024; 48:337-344. [PMID: 38430136 DOI: 10.1002/jpen.2615] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/08/2023] [Revised: 02/05/2024] [Accepted: 02/05/2024] [Indexed: 03/03/2024]
Abstract
BACKGROUND Feeding problems are common in children with complex medical problems or acute critical illness and enteral nutrition may be required. In certain situations, gastric tube feeding is poorly tolerated or may not be feasible. When feed intolerance persists despite appropriate adjustments to oral and gastric enteral regimens, jejunal tube feeding can be considered as an option for nutrition support. METHODS A multidisciplinary expert working group of the Australasian Society of Parenteral and Enteral Nutrition was convened. They identified topic questions and five key areas of jejunal tube feeding in children. Literatures searches were undertaken on Pubmed, Embase, and Medline for all relevant studies, between January 2000 and September 2022 (n = 103). Studies were assessed using National Health and Medical Research Council guidelines to generate statements, which were discussed as a group, followed by voting on statements using a modified Delphi process to determine consensus. RESULTS A total of 24 consensus statements were created for five key areas: patient selection, type and selection of feeding tube, complications, clinical use of jejunal tubes, follow-up, and reassessment. CONCLUSION Jejunal tube feeding is a safe and effective means of providing nutrition in a select group of pediatric patients with complex medical needs, who are unable to be fed by gastric tube feeding. Appropriate patient selection is important as complications associated with jejunal tube feeding are not uncommon, and although mostly minor, can be significant or require tube reinsertion. All children receiving jejunal tube feeding should have multidisciplinary team assessment and follow-up.
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Affiliation(s)
- Kathleen H McGrath
- Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
| | - Tanya Collins
- Department of Nutrition and Dietetics, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Annabel Comerford
- Nutrition Department, Women's and Children's Hospital, Adelaide, South Australia, Australia
| | - Zoe McCallum
- Department of Gastroenterology and Clinical Nutrition, The Royal Children's Hospital, Melbourne, Victoria, Australia
- Department of Paediatrics, The University of Melbourne, Melbourne, Victoria, Australia
- Department of Neurodevelopment and Disability, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Michaela Comito
- Department of Nutrition and Food Services, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Kim Herbison
- Department of Paediatric Dietetics, Starship Children's Hospital, Auckland, New Zealand
| | - Olivia Rose Cochrane
- Department of Paediatric Dietetics, Starship Children's Hospital, Auckland, New Zealand
| | - Deirdre Mary Burgess
- Department of Paediatric Gastroenterology, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Sarah Kane
- Department of Dietetics and Food Services, Queensland Children's Hospital, Brisbane, Queensland, Australia
| | - Keryn Coster
- Department of Nutrition and Food Services, The Royal Children's Hospital, Melbourne, Victoria, Australia
| | - Michele Cooper
- Department of Paediatric Gastroenterology, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
| | - Kathryn Jesson
- Department of Paediatric Gastroenterology, John Hunter Children's Hospital, Newcastle, New South Wales, Australia
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Faccioli N, Sierra A, Mosca A, Bellaïche M, Lengliné H, Bonnard A, Viala J. Jejunal Feeding by Gastrojejunal Tube in Pediatric Refractory Gastroesophageal Reflux Disease. J Pediatr Gastroenterol Nutr 2023; 77:267-273. [PMID: 37477887 DOI: 10.1097/mpg.0000000000003785] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 07/22/2023]
Abstract
OBJECTIVES The objective of this study is to determine whether jejunal nutrition by gastrojejunal tube (GJT) could be a therapeutic option for refractory gastroesophageal reflux disease (GERD), avoiding further antireflux surgery. METHODS A monocentric retrospective study was conducted for all children <18 years who underwent GJT placement to treat GERD. We collected data at the first GJT placement, 5 months after last GJT withdrawal, and at the end of the follow-up (June 2021). RESULTS Among 46 GERD patients with 86 GJT, 32 (69.6%) and 30 (65.2%) avoided antireflux surgery 5 and 28 months, respectively, after the definitive GJT removal. Five months after GJT removal, discharge from hospital, transition to gastric nutrition, GERD complications, and treatment were significantly improved. Median age and weight at the first GJT placement were 7 months and 6.8 kg. Patients had digestive comorbidities or complicated GERD in 69.6% and 76.1% patients, respectively. The median duration of jejunal nutrition using GJT was 64.5 days. GJT had to be removed in 63 (75.9%) cases for technical problems. CONCLUSIONS Jejunal nutrition by GJT could be an alternative to antireflux surgery avoiding sustainably antireflux surgery in most of complicated GERD patients. The high frequency of mechanical complications raises that these devices should be technically improved.
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Affiliation(s)
- Nathan Faccioli
- From the Department of Pediatric Gastroenterology and Nutrition, Robert-Debré Universitary Hospital, APHP, Paris, France
| | - Anaïs Sierra
- From the Department of Pediatric Gastroenterology and Nutrition, Robert-Debré Universitary Hospital, APHP, Paris, France
- University of Paris-Cité, Paris, France
- the Department of Pediatrics, Hôpital Femme-Mère-Enfant, Hospices Civils de Lyon, Lyon, France
| | - Alexis Mosca
- From the Department of Pediatric Gastroenterology and Nutrition, Robert-Debré Universitary Hospital, APHP, Paris, France
| | - Marc Bellaïche
- From the Department of Pediatric Gastroenterology and Nutrition, Robert-Debré Universitary Hospital, APHP, Paris, France
| | - Hélène Lengliné
- From the Department of Pediatric Gastroenterology and Nutrition, Robert-Debré Universitary Hospital, APHP, Paris, France
| | - Arnaud Bonnard
- University of Paris-Cité, Paris, France
- the Department of Pediatric Surgery and Urology, Robert-Debré Universitary Hospital, APHP, Paris, France
- INSERM UMR 1149, Paris, France
| | - Jérôme Viala
- From the Department of Pediatric Gastroenterology and Nutrition, Robert-Debré Universitary Hospital, APHP, Paris, France
- University of Paris-Cité, Paris, France
- INSERM UMR 1149, Paris, France
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Dipasquale V, Aumar M, Ley D, Antoine M, Romano C, Gottrand F. Tube Feeding in Neurologically Disabled Children: Hot Topics and New Directions. Nutrients 2022; 14:nu14183831. [PMID: 36145204 PMCID: PMC9506511 DOI: 10.3390/nu14183831] [Citation(s) in RCA: 6] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/22/2022] [Revised: 09/12/2022] [Accepted: 09/13/2022] [Indexed: 11/24/2022] Open
Abstract
Tube feeding is a therapeutic intervention that is aimed at providing nutritional support and is important in the nutritional and gastrointestinal management of children with neurological disability (ND) worldwide. Since the publication of the first European Society of Gastroenterology, Hepatology, and Nutrition (ESPGHAN) consensus paper in 2017, some aspects of tube-feeding modalities have attracted the interest of the scientific community more than others, including the type of enteral formulas, enteral access, and the challenging practice of tube weaning. The purpose of this review was to report on the most recent hot topics and new directions in tube-feeding strategies for children with ND.
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Affiliation(s)
- Valeria Dipasquale
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University Hospital “G. Martino”, 98124 Messina, Italy
- CHU Lille Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children’s Hospital, F59000 Lille, France
- Correspondence:
| | - Madeleine Aumar
- CHU Lille Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children’s Hospital, F59000 Lille, France
- University Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, F59000 Lille, France
| | - Delphine Ley
- CHU Lille Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children’s Hospital, F59000 Lille, France
- University Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, F59000 Lille, France
| | - Matthieu Antoine
- CHU Lille Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children’s Hospital, F59000 Lille, France
| | - Claudio Romano
- Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood “G. Barresi”, University Hospital “G. Martino”, 98124 Messina, Italy
| | - Frédéric Gottrand
- CHU Lille Division of Gastroenterology, Hepatology and Nutrition, Department of Paediatrics, Jeanne de Flandre Children’s Hospital, F59000 Lille, France
- University Lille, U1286-INFINITE-Institute for Translational Research in Inflammation, F59000 Lille, France
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