ENTERAL NUTRITIONAL SUPPORT BY GASTROSTOMY TUBE IN CHILDREN WITH CANCER

We examined the use of gastrostomy tubes in malnourished children with cancer as part of our ongoing efforts to improve their supportive car e, Patients were examined on the basis of percentage of weight loss an d percentage of desirable body weight. Twenty-five patients underwent gastrostomy tube placement followed by aggressive enteral nutritional support. Gastrostomy tubes were placed at a mean of 3.5 months (range, 0.3 to 8 months) after diagnosis; mean weight loss had been 10.1% (ra nge, to 21%) of desirable body weight, There were no immediate postope rative complications. Gastrostomy tube feedings were well tolerated by all patients. All children gained or maintained weight, and 60% of th e severely malnourished children returned to a desirable body weight a fter an average of 4.9 months (range, 1 to 13 months). Weight gain ave raged 12.9% (range, to 45.4%) of desirable body weight. The most commo n complications were 38 episodes of inflammation at the gastrostomy tu be site during periods of severe neutropenia, which were treated succe ssfully with topically or orally administered antibiotics, and 13 epis odes of cellulitis, which required intravenously administered antibiot ics. The infection rate was 1.58 episodes per 1000 days of use compare d with a rate of 5.0 per 1000 days previously reported with total pare nteral nutrition. The monthly costs of gastrostomy tube nutrition supp ort were 9% of those associated with use of total parenteral nutrition . Gastrostomy tube use in children with cancer is a safe, effective, a nd cost-effective method of reversing malnutrition, Further investigat ion with larger numbers of patients is warranted.