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Percutaneous endoscopic gastrostomy in small medically complex infants
1Dept. of Pediatrics, The Johns Hopkins University School of Medicine, Baltimore, Maryland, USA.
Insights
Percutaneous endoscopic gastrostomy (PEG) is safe for infants under 3.5 kg. While pneumoperitoneum can occur, it usually requires intervention only in these small patients.
Area of Science:
- Pediatric Gastroenterology
- Minimally Invasive Surgery
- Neonatal Care
Background:
- Percutaneous endoscopic gastrostomy (PEG) is common in pediatrics.
- Limited data exists on PEG safety in infants < 3.5 kg.
Purpose of the Study:
- To evaluate the safety and feasibility of PEG in infants weighing less than 3.5 kg.
Main Methods:
- Retrospective chart review of 26 infants (< 3.5 kg) who underwent PEG placement.
- Procedures performed under general anesthesia using 14- or 15-Fr tubes.
Main Results:
- All 26 PEG placements were successful.
- Minor complications included pneumoperitoneum (7.6%), skin erythema (7.6%), and cellulitis (3.8%).
- Tube removal by traction was successful in 61.5% of cases.
Conclusions:
- PEG insertion is a safe procedure for very small, medically complex infants.
- Pneumoperitoneum in this population may necessitate intervention.
Background And Study Aims:
Percutaneous endoscopic gastrostomy (PEG) is an established procedure for pediatric patients; however, there is still relatively little information on its feasibility and safety in very small infants. The aim of this study was to investigate the safety of percutaneous endoscopic gastrostomy in infants weighing less than 3.5 kg.
Patients And Methods:
The charts of 26 infants weighing less than 3.5 kg who received PEGs were retrospectively reviewed.
Results:
At the time of gastrostomy insertion the mean weight was 3 kg and the mean age was 2.3 months. This population of infants carried multiple diagnoses including lung disease of prematurity, swallowing dysfunction, chromosomal abnormality, structural facial anomaly, neurological deficit and congenital heart disease. Infants received either a 14- or 15-Fr percutaneous endoscopic gastrostomy tube under general anesthesia. All 26 procedures were successfully completed. Two infants (7.6%) developed a pneumoperitoneum during the procedure which required intervention. Two infants (7.6%) were conservatively treated with oral antibiotics for mild skin erythema and one infant (3.8%) required intravenous antibiotics for cellulitis of the stoma site. There were no other complications. To date, 16 of the gastrostomy tubes (61.5%) have been removed by traction without complication.
Conclusions:
PEGs can be safely placed in very small, medically complex infants. Pneumoperitoneum, which is a common but usually insignificant occurrence in adults and children during PEG placement, may require intervention in the small infant.