Gastrostomy Tubes Placed in Children With Neurologic Impairment: Associated Morbidity and Mortality

Area of Science:

• Pediatric Gastroenterology
• Pediatric Pulmonology
• Clinical Outcomes Research

Background:

• Gastrostomy tube (G-tube) placement is considered for pneumonia prevention in children with neurologic impairment and dysphagia.
• Previous research indicates a potential association between G-tube placement and increased pneumonia risk.
• This study investigates the relationship between the timing of G-tube placement and severe outcomes in this vulnerable population.

Purpose of the Study:

• To evaluate the association between the timing of gastrostomy tube (G-tube) placement and the risk of death or severe pneumonia in children with neurologic impairment.
• To compare outcomes for children with neurologic impairment who received a G-tube versus those who did not.

Main Methods:

• A cohort study using California Children's Services data (2009-2014) of children with neurologic impairment and a prior pneumonia hospitalization.
• Propensity score matching was used to create comparable groups of children with and without new G-tubes.
• Time-varying Cox proportional hazard models analyzed the risk of death or a composite outcome of death/severe pneumonia.

Main Results:

• Children with new G-tubes showed a reduced risk of death (HR 0.47) compared to those without.
• However, children with new G-tubes had an increased risk of the composite outcome of death or severe pneumonia (HR 1.21).
• More recent G-tube placement correlated with greater death risk reduction but a higher risk of severe pneumonia.

Conclusions:

• Recent G-tube placement in children with neurologic impairment is linked to a lower risk of death.
• Conversely, recent G-tube placement is associated with an elevated risk of severe pneumonia.
• Clinical decisions regarding G-tube placement for pulmonary reasons must balance the potential benefits against the impact of severe pneumonia on quality of life.