Effectiveness of Fundoplication or Gastrojejunal Feeding in Children With Neurologic Impairment.
Effectiveness of Fundoplication or Gastrojejunal Feeding in Children With Neurologic Impairment.
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DOI：
10.1542/hpeds.2016-0126
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发表时间：
2017-03-01
影响因子：
--
通讯作者：
Srivastava, Rajendu
中科院分区：
文献类型：
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作者：
Stone, Bryan;Hester, Gabrielle;Srivastava, Rajendu
背景和目的：胃食管反流（格尔）、误吸和继发性并发症导致神经功能缺损（NI）、吞咽困难和胃造口术喂养儿童的发病率和死亡率。胃底折叠术和胃空肠（GJ）喂养可以降低风险。我们使用术后第一年反流相关住院（RRH）率比较GJ和胃底折叠术。方法：我们确定了2007年1月1日至2012年12月31日期间接受初始GJ放置或胃底折叠术的NI、吞咽困难需要胃造口管喂养和格尔的儿童。数据来自儿科健康信息系统，并得到了实验室、微生物学和放射学结果的补充。根据影像学检查结果和国际疾病分类第九版临床修改代码进行胃底折叠术确定GJ位置。使用倾向评分在医院内匹配受试者。主要结局是术后第一年RRH率（因格尔病、其他食管炎、吸入性肺炎、其他肺炎、哮喘或机械通气住院）。次要结果包括未能茁壮成长，死亡，重复初始干预，交叉干预，和程序complications.Results：我们确定了1178例儿童胃底折叠术和163 GJ放置，每组匹配114。GJ和胃底折叠术每儿童年的匹配样本RRH发生率（95%置信区间）分别为2.07（1.62-2.64）和1.67（1.28-2.18），P = 0.19。两组之间的死亡率相似。未能茁壮成长，重复初始干预，交叉干预更常见于GJ group.CONCLUSIONS：在儿童NI，格尔，吞咽困难：胃底折叠术和GJ喂养有类似的RRH的结果。任何一种干预都可以降低未来的误吸风险;选择可以反映非RRH相关并发症风险、护理人员偏好和临床医生建议。
BACKGROUND AND OBJECTIVES: Gastroesophageal reflux (GER), aspiration, and secondary complications lead to morbidity and mortality in children with neurologic impairment (NI), dysphagia, and gastrostomy feeding. Fundoplication and gastrojejunal (GJ) feeding can reduce risk. We compared GJ to fundoplication using first-year postprocedure reflux-related hospitalization (RRH) rates.METHODS: We identified children with NI, dysphagia requiring gastrostomy tube feeding and GER undergoing initial GJ placement or fundoplication from January 1, 2007 to December 31, 2012. Data came from the Pediatric Health Information Systems augmented by laboratory, microbiology, and radiology results. GJ placement was ascertained using radiology results and fundoplication by International Classification of Diseases, Ninth Revision, Clinical Modification codes. Subjects were matched within hospital using propensity scores. The primary outcome was first-year postprocedure RRH rate (hospitalization for GER disease, other esophagitis, aspiration pneumonia, other pneumonia, asthma, or mechanical ventilation). Secondary outcomes included failure to thrive, death, repeated initial intervention, crossover intervention, and procedural complications.RESULTS: We identified 1178 children with fundoplication and 163 with GJ placement, matching 114 per group. Matched sample RRH incident rate per child-year (95% confidence interval) for GJ was 2.07 (1.62-2.64) and for fundoplication 1.67 (1.28-2.18), P = .19. Odds of death were similar between groups. Failure to thrive, repeat of initial intervention, and crossover intervention were more common in the GJ group.CONCLUSIONS: In children with NI, GER, and dysphagia: fundoplication and GJ feeding have similar RRH outcomes. Either intervention can reduce future aspiration risk; the choice can reflect non-RRH-related complication risks, caregiver preference, and clinician recommendation.