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External leakage from feeding gastrostomies in patients receiving valproate sprinkle
C Jones-Saete1, R L Kriel, J C Cloyd
1Gillette Children's Hospital, Minneapolis, Minnesota.
Insights
Valproate sprinkle (VPA-S) administration through feeding gastrostomies in children may increase external leakage. Frequent tube changes or larger tubes may reduce VPA-S leakage complications, especially with button feeding tubes.
Area of Science:
- Pediatric Gastroenterology
- Gastrointestinal Drug Delivery
Background:
- External leakage from feeding gastrostomies is a clinical concern.
- Valproate sprinkle (VPA-S) is used for seizure management in children.
Purpose of the Study:
- To investigate the incidence of external leakage associated with VPA-S administration via feeding gastrostomies.
- To identify risk factors and potential management strategies for VPA-S-related gastrostomy leakage.
Main Methods:
- Retrospective review of 8 patients receiving VPA-S through feeding gastrostomies.
- Comparison with a control group of 31 children with feeding gastrostomies not receiving VPA-S.
- Analysis of complication rates, focusing on external leakage and occlusion.
Main Results:
- Four out of 8 children (50%) receiving VPA-S developed recurrent external leakage.
- The control group had a leakage incidence of 6.4% (2 out of 31).
- All patients with button feeding tubes receiving VPA-S experienced leakage or occlusion complications.
Conclusions:
- VPA-S administration through feeding gastrostomies is associated with a higher incidence of external leakage.
- Leakage may be caused by undissolved VPA-S particles adhering to the tube exterior.
- Frequent tube changes, larger tube sizes, and avoidance of VPA-S with button feeding tubes are recommended.
Abstract:
We reviewed the incidence of external leakage from feeding gastrostomies in 8 patients who received valproate sprinkle (VPA-S). We also identified a control group of 31 children with feeding gastrostomies who were also cared for in our clinic, but who did not receive VPA-S. All patients in both groups have had their feeding gastrostomy greater than or equal to 6 months. Four of 8 children who received VPA-S through feeding gastrostomies developed problems with recurrent external leakage. The incidence of external leakage in our control group of children who had not received VPA-S was 2 in 31 (6.4%). We hypothesize that the external leakage is caused by adherence of the undissolved VPA-S particles to the exterior of the tube, preventing close approximation of the tube to the gastrostomy stoma. In most cases, VPA-S could continue to be administered and the problem of leakage reduced if the tubes were more frequently changed and/or a larger size were used. Complications with either leakage or occlusion were noted in all patients with the button feeding tube who had received VPA-S. Because of the especially high complication rate associated with administration of VPA-S in children with the "button" feeding tubes, we discourage VPA-S administration to children with that device.