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Enterostomy tube placement in children with spinal muscular atrophy type 1
1Division of Paediatric Medicine and Paediatric Outcomes Research Team, the Department of Paediatrics, The Hospital for Sick Children, University of Toronto, Ontario, Canada.
Insights
Infants with spinal muscular atrophy (SMA) type 1 experienced significant complications, including death, within 30 days of enterostomy tube insertion. Aspiration pneumonia was the most frequent major complication in this vulnerable population.
Area of Science:
- Pediatric Gastroenterology
- Neuromuscular Disorders
- Interventional Radiology
Background:
- Spinal muscular atrophy (SMA) type 1 is a severe neuromuscular disorder affecting infants.
- Enterostomy tube insertion is often necessary for nutritional support in infants with SMA type 1.
- The safety and complication rates of enterostomy tube placement in this specific population require detailed investigation.
Purpose of the Study:
- To evaluate the incidence of major complications within 30 days following enterostomy tube insertion in infants diagnosed with SMA type 1.
- To identify specific types of major complications encountered post-procedure.
Main Methods:
- Retrospective case review of pediatric patients with SMA type 1 who underwent image-guided gastrostomy or gastrojejunostomy tube placement.
- Data collected from 1994-2004 at a single pediatric tertiary care center.
- Major complications defined as peritonitis, aspiration pneumonia, respiratory failure, nonelective PICU admission, and mortality.
Main Results:
- Twelve infants with SMA type 1 met the inclusion criteria.
- Aspiration pneumonia occurred in 41.6% of patients, respiratory failure in 33%, and mortality in 16.7% within 30 days.
- Older age at tube insertion was significantly associated with the development of aspiration pneumonia (P < .05).
Conclusions:
- Enterostomy tube insertion in infants with SMA type 1 is associated with a substantial rate of major complications, including life-threatening events.
- Close monitoring and consideration of patient age are crucial in the peri-procedural management of these infants.
- These findings highlight the risks inherent in providing enteral access for infants with severe neuromuscular disease.
Objective:
To determine the major complication rate in the first 30 days after enterostomy tube insertion in infants with spinal muscular atrophy (SMA) type 1.
Study Design:
A retrospective case review of all children with SMA type 1 who had a gastrostomy or gastrojejunostomy tube placed by the image-guided technique at the Hospital for Sick Children from 1994-2004. Major complications were classified as peritonitis, aspiration pneumonia, respiratory failure, nonelective admission to the pediatric intensive care unit, and death.
Results:
Twelve children were identified as having SMA type 1 with an enterostomy tube insertion. The median age at tube insertion was 6.1 months (range 2.2 to 15.8 months). Major complications in the first 30 days after the procedure included aspiration pneumonia (5/12 patients [41.6%]), respiratory failure requiring admission to the pediatric intensive care unit (4/12 [33%]), and death (2/12 [16.7%]). Children with development of aspiration pneumonia were significantly older at time of tube insertion (P < .05) than those with no aspiration.
Conclusions:
Major complications including death are seen in children with SMA type 1 in the first 30 days after enterostomy tube insertion.
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