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Gastrostomy feeding versus oral feeding alone for children with cerebral palsy
Insights
This review found no trials on nutritional supplementation via gastrostomy or jejunostomy for children with cerebral palsy (CP). More research is needed to understand the effects of these feeding methods for children with CP.
Area of Science:
- Pediatric Gastroenterology
- Neurology
- Clinical Nutrition
Background:
- Children with cerebral palsy (CP) often experience severe feeding difficulties, impacting nutrition and potentially causing aspiration.
- Alternative feeding methods like gastrostomy or jejunostomy tubes are used when oral feeding is insufficient, but their effectiveness requires evaluation.
- These interventions can be emotionally challenging for caregivers and are costly, necessitating a thorough assessment of their benefits.
Purpose of the Study:
- To systematically assess the effects of nutritional supplementation administered via gastrostomy or jejunostomy in children diagnosed with feeding difficulties secondary to cerebral palsy.
Main Methods:
- A comprehensive literature search was conducted across multiple databases including Cochrane Library, MEDLINE, EMBASE, CINAHL, LILACS, ASLIB, and Dissertation Abstracts up to December 2003.
- Inclusion criteria were limited to randomized controlled trials comparing nutrition delivery via gastrostomy or jejunostomy tubes against oral feeding alone in children up to 16 years of age.
- Trial selection, data extraction, and quality assessment were performed independently by two reviewers to ensure rigorous methodology.
Main Results:
- The systematic search and review process identified no randomized controlled trials that met the predefined inclusion criteria.
- Consequently, no data were available to analyze the effects of nutritional supplementation via gastrostomy or jejunostomy in this population.
Conclusions:
- Significant uncertainty persists regarding the efficacy and impact of gastrostomy feeding in children with cerebral palsy due to a lack of high-quality evidence.
- There is a critical need for well-designed, randomized controlled trials to address the current knowledge gaps and inform optimal medical management for children with CP and associated feeding impairments.
Background:
Children with cerebral palsy (CP) can be significantly disabled in terms of their ability to suck, chew and swallow. This can lead to significant impairment in feeding ability and, eventually, to under-nutrition. It can also result in aspiration of food into the lungs. Feeding time may be considerably increased and, instead of being an enjoyable experience, mealtimes may be distressing for both the child and carer. Increasingly for children unable to maintain a normal nutritional state feeding by mouth, gastrostomy or jejunostomy tubes are being used to provide the digestive system with nutrients. A gastrostomy tube is a feeding tube inserted surgically through the abdominal wall directly into the stomach. A jejunostomy feeding tube is inserted into the jejunum, part of the small intestine, either directly or via a previous gastrostomy. Although gastrostomy or jejunostomy placement may greatly facilitate feeding of children with CP, many carers find it very difficult to accept this intervention emotionally. The treatment is also relatively costly. For all of these reasons, its effectiveness requires assessment.
Objectives:
To assess the effects of nutritional supplementation given via gastrostomy or jejunostomy in children with feeding difficulties due to cerebral palsy.
Search Strategy:
We searched the Cochrane Library's register of controlled trials (CENTRAL) up to Issue 4, 2003, MEDLINE 1977 - December 2003, EMBASE 1980 - December 2003, CINAHL 1982 - December 2003, LILACS 1980 - end 2003, ASLIB 1983 - 2003 and Dissertation Abstracts 1980 - 2003.
Selection Criteria:
Only randomised controlled trials which compared delivery of nutrition via a gastrostomy or jejunostomy tube compared with oral feeding alone for children up to the age of 16 were considered for this review.
Data Collection And Analysis:
Selection of trials, data extraction and assessment of trial quality were undertaken independently by two reviewers.
Main Results:
No trials were identified that met the inclusion criteria for this review.
Reviewers' Conclusions:
On the basis of this systematic review, considerable uncertainty about the effects of gastrostomy for children with cerebral palsy remains. A well designed and conducted randomised controlled trial should be undertaken to resolve the current uncertainties about medical management for children with cerebral palsy and physical difficulties in eating.
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