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Major complications of jejunal feeding in children

Conor McCann1, Paul S Cullis1, Amanda J McCabe1

  • 1Department of Paediatric Surgery, Royal Hospital for Sick Children, Edinburgh, UK.

Journal of Pediatric Surgery
|December 12, 2018
PubMed

Insights

Jejunal feeding can lead to serious gastrointestinal complications, including bowel ischemia, intussusception, and volvulus, particularly in fragile, neurologically impaired children. These risks necessitate careful patient selection and informed consent.

Area of Science:

  • Pediatric Surgery
  • Gastroenterology
  • Clinical Outcomes Research

Background:

  • Direct jejunal feeding is utilized for nutritional support in pediatric patients with complex gastrointestinal issues.
  • Potential complications associated with jejunal feeding require thorough investigation to ensure patient safety.

Purpose of the Study:

  • To identify and characterize major gastrointestinal complications arising from direct jejunal feeding in a pediatric population.
  • To hypothesize the potential for life-threatening surgical complications in a subset of patients receiving jejunal feeding.

Main Methods:

  • Retrospective analysis of 197 pediatric patients who received jejunal feeding between 2008 and 2018.
  • Data collection included patient demographics, comorbidities, feeding methods, and adverse events, with complications graded by Clavien-Dindo criteria (≥ IIIb).
  • Study design classified as Level IV prognosis.

Main Results:

  • 14 significant gastrointestinal complications occurred in 12 patients, with 11 classified as major (Clavien-Dindo grade > IIIb).
  • Complications included non-mechanical bowel ischemia (n=7), intussusception (n=4), and volvulus (n=3), leading to bowel resections in 8 patients and 2 deaths.
  • Neurologically impaired children constituted the majority (122/197) of patients receiving jejunal feeding.

Conclusions:

  • Jejunal feeding is associated with a significant, underreported risk of major gastrointestinal compromise, including a 6.1% risk of major surgical complications.
  • A notable 3.6% of patients experienced bowel ischemia of unknown etiology, highlighting a critical risk factor.
  • Comorbid, fragile, and neurologically impaired children are particularly susceptible, underscoring the need for comprehensive parental counseling and informed consent prior to initiating jejunal feeding.
Abstract

Keywords:
Bowel ischemiaComplicationsGastrojejunostomyJejunal feedingNasojejunalRoux-en-Y

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