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Early Tube Feeding Improves Nutritional Outcomes in Children with Neurological Disabilities: A Retrospective Cohort
Valeria Dipasquale1, Ugo Cucinotta1, Angela Alibrandi2
1Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", "G. Martino" University Hospital, 98124 Messina, Italy.
Insights
Tube feeding significantly improves nutritional status and reduces symptoms in children with neurological disabilities. Early initiation of tube feeding with commercial formulas is recommended for optimal outcomes in pediatric patients.
Area of Science:
- Pediatric Gastroenterology
- Neurology
- Clinical Nutrition
Background:
- Children with neurological disabilities (ND) often face malnutrition and feeding difficulties.
- Tube feeding is a critical intervention but its widespread use and outcomes require further evaluation.
- Early intervention is key for managing complex pediatric feeding disorders.
Purpose of the Study:
- To assess the outcomes of exclusive tube feeding in a cohort of children with neurological disabilities.
- To evaluate nutritional status changes and symptom improvement following gastrostomy placement.
- To identify factors influencing the effectiveness of tube feeding in this population.
Main Methods:
- Retrospective study of 50 children with ND who underwent gastrostomy for tube feeding over 5 years.
- Collected anthropometric data (weight-for-age, BMI, MUAC Z-scores) and symptoms at baseline, 6, and 12 months.
- Analyzed data based on underlying disease, feeding indications, and formula type.
Main Results:
- Tube feeding led to significant increases in weight and BMI Z-scores over 12 months.
- Most symptoms, including cough, vomiting, and diarrhea, showed significant improvement (p < 0.05).
- Longer disease duration at intervention onset correlated with poorer nutritional status normalization at 12 months.
Conclusions:
- Exclusive tube feeding is effective in improving nutritional status and alleviating symptoms in children with neurological disabilities.
- Early initiation of tube feeding, particularly with commercially available enteral formulas, is crucial for maximizing positive outcomes.
- While generally safe, potential complications like track disruption and skin infections should be monitored.
Abstract:
Tube feeding is a life-saving treatment for children with neurological disabilities (ND), who often suffer from malnutrition and feeding disorders. Nonetheless, it is still not widely used. Our aim was to evaluate the outcomes of exclusive tube feeding in a cohort of ND children. All consecutive ND children who started tube feeding at our center within the last 5 years were included in this retrospective study. Weight-for-age, body mass index (BMI), mid-upper arm circumference (MUAC) Z-scores, and symptoms were collected at baseline (V0), 6 (V1), and 12 months (V2) after gastrostomy placement. Fifty children (62% males) were included. The ND-underlying disease was genetic (n = 29, 58%), hypoxic-ischemic encephalopathy (n = 17, 34%), or metabolic (n = 4, 8%). Indications for tube feeding were malnutrition (n = 35, 70%), recurrent respiratory infections (n = 11, 22%), or both (n = 4, 8%). Enteral formulae were polymeric (n = 29, 58%), semi-elemental (n = 17, 34%), hypercaloric (n = 3, 6%), or elemental (n = 1, 2%). Homemade blended feed was offered to three children (6%) in addition to the formula. Weight and BMI increased over the study period. Except for constipation, all symptoms (cough, vomiting, and diarrhea) improved at 6 and 12 months (p < 0.05). Non-serious complications (n = 8; track disruption, granuloma, and skin infection) were observed. Longer disease duration (p < 0.001) at the start of tube feeding was associated with the absence of normalization of nutritional status (BMI Z-score > 2 SD) at 12 months. Tube feeding with commercially available enteral formulae should be started as early as possible for better outcomes.
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