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Pediatric gastrostomy

Wednesday Marie A Sevilla, Barbara McElhanon
Enteral nutrition is delivered via the gastrointestinal tract when oral intake is not sufficient to maintain nutrition status. There is evidence that long-term home enteral nutrition (HEN) can be advantageous to pediatric patients by improving quality of life and function. Data from pediatric patients receiving either nasogastric tube or gastrostomy tube feeds indicate good outcomes in terms of maintaining and improving nutrition status as evidenced by anthropometric measurements. As the number of pediatric patients requiring HEN increases, development of an effective program to allow smooth transition to the home is necessary...
October 18, 2016: Nutrition in Clinical Practice
John F Gamble, Dinesh J Kurian, Andrea G Udani, Nathaniel H Greene
We present a case of a 3-month-old female with Wolf-Hirschhorn syndrome (WHS) undergoing general anesthesia for laparoscopic gastrostomy tube placement with a focus on airway management. WHS is a rare 4p microdeletion syndrome resulting in multiple congenital abnormalities, including craniofacial deformities. Microcephaly, micrognathia, and glossoptosis are common features in WHS patients and risk factors for a pediatric airway that is potentially difficult to intubate. We discuss anesthesia strategies for airway preparation and management in a WHS patient requiring general anesthesia with endotracheal intubation...
2016: Case Reports in Pediatrics
Anna M Follent, Anna F Rumbach, Elizabeth C Ward, Jeanne Marshall, Pamela Dodrill, Peter Lewindon
PURPOSE: There is limited information regarding the nature of dysphagia and feeding difficulties following alkali ingestion injury to inform multidisciplinary intervention. The aim was to describe the history and nature of chronic dysphagia and feeding difficulties in two children following severe alkali ingestion injury. METHODS: Medical records, primary caregiver report, and clinical assessment were used to compile detailed case histories and assess current dysphagia and feeding skills...
October 7, 2016: Disability and Rehabilitation
Laura Merli, Erika A De Marco, Camilla Fedele, Elena J Mason, Alessandra Taddei, Filomena V Paradiso, Vincenzo D Catania, Lorenzo Nanni
The aim of this study is to compare the outcomes and the complications between the 2 most adopted procedures for gastrostomy placement: percutaneous endoscopic gastrostomy (PEG) and laparoscopic gastrostomy (LG) in children. We present our study on 69 patients (male: 46/female: 23): group 1 (37 patients, 54%) undergoing PEG, group 2 (32 patients, 46%) undergoing LG. A total of 5 major complications were observed all in the PEG group (13.5%), no major complication was observed in the LG group (P-value<0.05)...
October 2016: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
Mike Thomson, Andrea Tringali, Rosario Landi, Jean-Marc Dumonceau, Marta Tavares, Jorge Amil-Dias, Marc Benninga, Merit M Tabbers, Raoul Furlano, Manon Spaander, Cesare Hassan, Christos Tzvinikos, Hanneke Ijsselstijn, Jérôme Viala, Luigi Dall'Oglio, Rok Orel, Yvan Vandenplas, Radan Keil, Štěpán Hlava, Claudio Romano, Eva Brownstone, Patrick Gerner, Werner Dolak, Wolf Dietrich Huber, Simon Everett, Andreas Vecsei, Lars Aabakken, Alessandro Zambelli
This Guideline refers to infants, children and adolescents aged 0-18 years. The areas covered include: indications for diagnostic and therapeutic esophagogastroduodenoscopy and ileo-colonoscopy; endoscopy for foreign body ingestion; corrosive ingestion and stricture/stenosis endoscopic management; upper and lower gastrointestinal bleeding; endoscopic retrograde cholangio-pancreatography and endoscopic ultrasonography. Percutaneous endoscopic gastrostomy and endoscopy specific to inflammatory bowel disease (IBD) has been dealt with in other Guidelines [1-3] and are therefore not mentioned in this Guideline...
September 12, 2016: Journal of Pediatric Gastroenterology and Nutrition
Andrea Tringali, Mike Thomson, Jean-Marc Dumonceau, Marta Tavares, Merit M Tabbers, Raoul Furlano, Manon Spaander, Cesare Hassan, Christos Tzvinikos, Hanneke Ijsselstijn, Jérôme Viala, Luigi Dall'Oglio, Marc Benninga, Rok Orel, Yvan Vandenplas, Radan Keil, Claudio Romano, Eva Brownstone, Štěpán Hlava, Patrick Gerner, Werner Dolak, Rosario Landi, Wolf Dietrich Huber, Simon Everett, Andreas Vecsei, Lars Aabakken, Jorge Amil-Dias, Alessandro Zambelli
This Executive summary of the Guideline on pediatric gastrointestinal endoscopy from the European Society of Gastrointestinal Endoscopy (ESGE) and the European Society for Paediatric Gastroenterology Hepatology and Nutrition (ESPGHAN) refers to infants, children, and adolescents aged 0 - 18 years. The areas covered include: indications for diagnostic and therapeutic esophagogastroduodenoscopy and ileocolonoscopy; endoscopy for foreign body ingestion; endoscopic management of corrosive ingestion and stricture/stenosis; upper and lower gastrointestinal bleeding; endoscopic retrograde cholangiopancreatography, and endoscopic ultrasonography...
September 12, 2016: Endoscopy
Kate Samela, Jasmeet Mokha, Karan Emerick, Zev H Davidovics
Due to concerns related primarily to allergic response and malabsorption, enteral nutrition therapy has traditionally relied on the use of elemental formulas in children with intestinal failure (IF). Blended food diets via a gastrostomy tube have been reported to improve feeding tolerance in pediatric populations receiving long-term enteral nutrition therapy. Complex macronutrients have been shown to stimulate intestinal adaptation in animal models. We report on our experience in children with IF who had an overall improvement in stool output when transitioned from an elemental formula to a tube feeding formula with real food ingredients (TFRF)...
August 4, 2016: Nutrition in Clinical Practice
Charleen Deo Singh
BACKGROUND: Skin damage under various drainage tubes and parenteral access lines occurs frequently in pediatric patients. Our team sought an alternative to the use of gauze or foam for prevention and management of peritubular skin damage. CASES: We used a moisture wicking fabric in select patients in a tertiary children's hospital in Northern California. The fabric was placed under tracheostomy ties and around gastrostomy tubes and Penrose drains. CONCLUSION: The moisture wicking fabric was effective in absorbing moisture and maintaining skin integrity...
September 2016: Journal of Wound, Ostomy, and Continence Nursing
Adam B Goldin, Kurt F Heiss, Matt Hall, David H Rothstein, Peter C Minneci, Martin L Blakely, Marybeth Browne, Mehul V Raval, Samir S Shah, Shawn J Rangel, Charles L Snyder, Charles D Vinocur, Loren Berman, Jennifer N Cooper, Marjorie J Arca
OBJECTIVES: To define the incidence of 30-day postdischarge emergency department (ED) visits and hospital readmissions following pediatric gastrostomy tube (GT) placement across all procedural services (Surgery, Interventional-Radiology, Gastroenterology) in 38 freestanding Children's Hospitals. STUDY DESIGN: This retrospective cohort study evaluated patients <18 years of age discharged between 2010 and 2012 after GT placement. Factors significantly associated with ED revisits and hospital readmissions within 30 days of hospital discharge were identified using multivariable logistic regression...
July 2016: Journal of Pediatrics
Fizan Abdullah, Jose H Salazar, Colin D Gause, Samir Gadepalli, Thomas W Biester, Kenneth S Azarow, Mary L Brandt, Dai H Chung, Dennis P Lund, Frederick J Rescorla, John H T Waldhausen, Thomas F Tracy, Mary E Fallat, Michael D Klein, Frank R Lewis, Ronald B Hirschl
IMPORTANCE: The number of practicing pediatric surgeons has increased rapidly in the past 4 decades, without a significant increase in the incidence of rare diseases specific to the field. Maintenance of competency in the index procedures for these rare diseases is essential to the future of the profession. OBJECTIVE: To describe the demographic characteristics and operative experiences of practicing pediatric surgeons using Pediatric Surgery Board recertification case log data...
August 1, 2016: JAMA Surgery
Tiffany J Zens, Deborah A Rusy, Ankush Gosain
BACKGROUND: Surgical wound classification (SWC) communicates the degree of contamination in the surgical field and is used to stratify risk of surgical site infection and compare outcomes among centers. We hypothesized that by changing from nurse-directed to surgeon-directed SWC during a structured operative debrief, we will improve accuracy of documentation. METHODS: An institutional review board-approved retrospective chart review was performed. Two time periods were defined: initially, SWC was determined and recorded by the circulating nurse (before debrief, June 2012-May 2013) and allowing 6 mo for adoption and education, we implemented a structured operative debriefing including surgeon-directed SWC (after debrief, January 2014-August 2014)...
April 2016: Journal of Surgical Research
Rachel Sunstrom, Nicholas Hamilton, Elizabeth Fialkowski, Katrine Lofberg, Julie McKee, Thomas Sims, Sanjay Krishnaswami, Kenneth Azarow
BACKGROUND: A protocol for laparoscopic gastrostomy placement was implemented which specified perioperative antibiotics, feeding regimens, and discharge criteria. Our hypothesis was that hospital cost could be decreased, whereas at the same time improving or maintaining patient outcomes. METHODS: Data were collected on consecutive patients beginning 6 months after implementation of our protocol. We recorded surgeon compliance, patient outcomes (as defined by 30-day NSQIP complication rates), and cost of initial hospitalization, which was then compare to a 6-month historical control period...
May 2016: American Journal of Surgery
Laura Watne, Michele L Yang
OBJECTIVE: To assess the effect of nutritional interventions on growth and on respiratory status in patients with congenital myopathy (CM), congenital muscular dystrophy (CMD), and congenital myasthenic syndrome (CMS). METHODS: Retrospective cohort study based on case-note review of 18 patients affected by CM, CMD, and CMS, followed at a single pediatric neuromuscular center, between 2006 and 2014. RESULTS: Seventy-two percent of patients required placement of a gastrostomy tube for bulbar weakness or for growth failure...
2016: Journal of Pediatric Rehabilitation Medicine
Israel Fernandez-Pineda, John A Sandoval, Reagan M Jones, Nana Boateng, Jianrong Wu, Bhaskar N Rao, Andrew M Davidoff, Stephen J Shochat
BACKGROUND: Complications in pediatric cancer patients after a gastrostomy (GT) placement have not been widely investigated. We aimed to evaluate the complication rate and nature of complications in this specific population. PROCEDURE: Medical records of pediatric cancer patients having a GT placed at our institution from 1998 to 2013 were retrospectively reviewed. Variables analyzed included gender, age, diagnosis, surgical procedure, GT device, duration of GT usage, absolute neutrophil count (ANC) level at surgery, and complications...
July 2016: Pediatric Blood & Cancer
Christina Kosar, Karen Steinberg, Nicole de Silva, Yaron Avitzur, Paul W Wales
BACKGROUND: Survival of children with intestinal failure has improved over the last decade, resulting in increased health care expenditures. Our objective was to determine outpatient costs for the first year after primary discharge. METHODS: A retrospective analysis was performed in pediatric intestinal failure (PIF) patients between 2010 and 2012. Patients were stratified into 3 groups (1=enteral support with no devices [7 patients], 2=enteral support with devices (gastrostomy and/or ostomy) [19 patients], 3=home parenteral nutrition (HPN) [22 patients])...
May 2016: Journal of Pediatric Surgery
Heather S Spader, Robert J Bollo, Christian A Bowers, Jay Riva-Cambrin
OBJECTIVE Intrathecal baclofen infusion systems to manage severe spasticity and dystonia are associated with higher infection rates in children than in adults. Factors unique to this population, such as poor nutrition and physical limitations for pump placement, have been hypothesized as the reasons for this disparity. The authors assessed potential risk factors for infection in a multivariate analysis. METHODS Patients who underwent implantation of a programmable pump and intrathecal catheter for baclofen infusion at a single center between January 1, 2000, and March 1, 2012, were identified in this retrospective cohort study...
June 2016: Journal of Neurosurgery. Pediatrics
Masahiro Zenitani, Shuichiro Uehara, Keigo Nara, Takehisa Ueno, Hideki Soh, Noriaki Usui, Hiroomi Okuyama
Percutaneous endoscopic gastrostomy (PEG) is a widely used minimally invasive procedure. However, PEG is difficult in neurologically impaired patients due to scoliosis with a high-riding stomach and intestinal dilatation. Fluoroscopy-guided PEG (F-PEG) is expected to avoid PEG-related complications such as intestinal injury and malpositioned tube placement. The aim of this retrospective study is to evaluate the feasibility and safety of F-PEG in children. Twenty-one handicapped pediatric patients underwent F-PEG from January 2012 to December 2014 at our hospital...
April 2016: Surgical Laparoscopy, Endoscopy & Percutaneous Techniques
Lauren A Destino, Madelyn Kahana, Shilpa J Patel
BACKGROUND: Increasingly, medical disciplines have used morbidity and mortality conferences (MMCs) to address quality improvement and patient safety (QI/PS), as well as teach systems-based improvement to graduate trainees. The goal of this educational intervention was to establish a pediatric resident physician–led MMC that not only focused on QI/PS principles but also engaged resident physicians in QI/ PS endeavors in their clinical learning environments. METHODS: Following a needs assessment, pediatric resident physicians at the Stanford University School of Medicine (Stanford, California) established a new MMC model in February 2010 as part of a required QI rotation...
March 2016: Joint Commission Journal on Quality and Patient Safety
Tuğba Koca, Ayşe Çiğdem Sivrice, Selim Dereci, Levent Duman, Mustafa Akçam
AIM: The aim of this study was to evaluate the demographic data and complication rates in children who had undergone percutaneous endoscopic gastrostomy in a three-year period in our Division of Pediatric Gastroenterology and to interrogate parental satisfaction. MATERIAL AND METHODS: The demographic data, complications and follow-up findings of the patients who had undergone percutaneous endoscopic gastrostomy between March 2011 and March 2014 were examined retrospectively using medical files...
December 2015: Türk Pediatri Arşivi
Huiwen Li, Sitang Gong, Min Yang, Peiyu Chen, Zhaohui Xu, Cuiping Liang, Tiefu Fang, Lu Ren, Liying Liu, Jiexia Li, Lanlan Geng
OBJECTIVE: To analyze the efficacy of percutaneous endoscopic gastrostomy (PEG) in pediatric patients. METHOD: From October 2011 to October 2014, children in the gastrointestinal ward of Guangzhou Women and Children's Medical Center received PEG or jejunal tube PEG(JET-PEG). The success rate, operation time were recorded. The changes of their weight, enteral nutrition calories and the incidence of pneumonia before and after the first 6 months of operation were compared...
February 2016: Zhonghua Er Ke za Zhi. Chinese Journal of Pediatrics
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