Improvement of children's nutritional status after enteral feeding by PEG:an interim report

Background: Enteral feeding by percutaneous endoscopic gastrostomy is indic ated as long-term nutritional support for children with neurologic impairme nt and dysphagia. We report our experience with percutaneous endoscopic gas trostomy and evaluate the age range of children with cerebral palsy who ben efit most with weight and height gain. Methods: In a prospective study, from August 1996 to August 1997, 20 endosc opic gastrostomies were performed in 20 children diagnosed with cerebral pa lsy (16), myopathy (2), and brain trauma (2). The mean age was 6.5 years an d the mean follow-up 5.9 months. All patients had severe mental impairment and oropharyngeal dysphagia. They were followed up monthly on an outpatient basis by both the gastroenterologist and the dietitian, who assessed gastr ostomy complications and performed anthropometric measurements. Results: All 20 patients benefited from enteral nutrition with a statistica lly significant gain in weight (p < 0.01), and there was a trend toward imp roved weight/height ratio in children under 4 years of age according to Z-s core and mid-arm muscle area (p < 0.01). Triceps skinfold thickness failed to reach statistical significance. There were no immediate complications re lated to the procedure. Perforations occurred with three (15%) tubes, and t he plugs for introduction of food had to be replaced after 4 months of use. All complications, namely formation of granulation tissue at the stoma (7) , stoma infection (4), gastroesophageal reflux pneumonia (3), and pneumoper itoneum (1) were managed clinically. Conclusions: Endoscopic gastrostomy is a safe procedure for children. Enter al feeding resulted in a trend toward a normalized weight/height ratio for children with cerebral palsy younger than 4 years and significant weight ga in in those older than 12 years.