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Gastrostomy feeding in infants and children on peritoneal dialysis
Sarah E Ledermann1, Lewis Spitz, Jeane Moloney
1Renal Unit, Great Ormond Street Hospital for Children NHS Trust, London WC1N 3JH, UK. leders@gosh.nhs.uk
Insights
Enteral feeding via gastrostomy is crucial for children on peritoneal dialysis (PD). Gastrostomy placement before PD is safer than during PD, with open gastrostomy (OG) being a safe alternative to percutaneous endoscopic gastrostomy (PEG) during PD.
Area of Science:
- Pediatric Nephrology
- Gastroenterology
- Surgical Procedures
Background:
- Enteral feeding is essential for growth in pediatric patients undergoing peritoneal dialysis (PD).
- Gastrostomy feeding is a common method to ensure adequate nutrition in these children.
- This study reviews the experience with gastrostomy feeding in children on PD.
Purpose of the Study:
- To evaluate the outcomes and complications of gastrostomy feeding in children on peritoneal dialysis.
- To compare the safety and efficacy of different gastrostomy procedures (PEG, N and G, OG) in relation to PD initiation.
- To provide recommendations for gastrostomy placement in pediatric PD patients.
Main Methods:
- Retrospective review of 29 children on PD requiring gastrostomy feeding over 11 years.
- Categorization into three groups based on the timing of gastrostomy placement relative to PD initiation.
- Analysis of gastrostomy-related complications, peritonitis rates, and outcomes.
Main Results:
- Children with gastrostomy placed before PD (Group 1) had lower peritonitis rates (0.6/patient year) compared to those with gastrostomy placed during PD (Group 2: 1.4/patient year).
- Percutaneous endoscopic gastrostomy (PEG) placement after PD initiation (Group 3) was associated with a higher incidence of peritonitis.
- Open gastrostomy (OG) or Nissen fundoplication and gastrostomy (N and G) procedures showed varied outcomes, with some complications like paraesophageal hernias and PEG track issues reported.
Conclusions:
- Gastrostomy placement prior to initiating PD is recommended, especially if an anti-reflux procedure is needed.
- Percutaneous endoscopic gastrostomy (PEG) placement during PD is contraindicated due to increased peritonitis risk.
- Open gastrostomy (OG) is a safe alternative for children requiring gastrostomy while on PD.
Abstract:
The majority of infants and young children on peritoneal dialysis (PD) require enteral feeding to achieve their growth potential. We report our experience of gastrostomy feeding in 29 children on PD over 11 years. Fifteen children, median age 3.9 (0.5-13.3) years had a percutaneous gastrostomy (PEG) or Nissen fundoplication and gastrostomy (N and G) or open gastrostomy (OG) before starting PD (group1). Nine children, age 0.7 (0.5-12.4) years, had a N and G or OG (group 2) and 5, age 5.1 (1-15.1) years, a PEG (group 3) after PD catheter insertion/start of PD. In group 1 (257 months gastrostomy feeding with PD), there were 0.6 episodes of peritonitis/patient year. Nine PEGs were replaced electively after 27 (19-50) months, with bleeding from an embedded flange the only complication. One PEG replaced by a button ruptured the track, causing Candida peritonitis. In group 2 (130 months G and PD), there were 1.4 episodes of peritonitis/patient year. Two children developed paraoesophageal hernias, which were successfully repaired. Four children in group 3 developed peritonitis soon after PEG placement. Two transferred to haemodialysis, 1 remained on PD after treatment of Candida peritonitis and 1 subsequently died. Only 2 of the 17 children who have had renal transplants still need gastrostomy feeds. We recommend placement of a PEG or OG if an anti-reflux procedure is necessary prior to starting PD. Placement of a PEG while on PD is contraindicated, but an OG is a safe alternative procedure.