Pediatric Advanced Care Team and
Division of Pediatric Medicine, Department of Pediatrics, Hospital for Sick Children, Toronto, Ontario, Canada.
Pediatrics. 2019 Feb;143(2). doi: 10.1542/peds.2018-2863.
Children with neurologic impairment (NI) often undergo feeding tube placement for undernutrition or aspiration. We evaluated survival and acute health care use after tube placement in this population.
This is a population-based exposure-crossover study for which we use linked administrative data from Ontario, Canada. We identified children aged 13 months to 17 years with a diagnosis of NI undergoing primary gastrostomy or gastrojejunostomy tube placement between 1993 and 2015. We determined survival time from procedure until date of death or last clinical encounter and calculated mean weekly rates of unplanned hospital days overall and for reflux-related diagnoses, emergency department visits, and outpatient visits. Rate ratios were estimated from negative binomial generalized estimating equation models adjusting for time and age.
Two-year survival after feeding tube placement was 87.4% (95% confidence interval [CI]: 85.2%-89.4%) and 5-year survival was 75.8% (95% CI: 72.8%-78.4%). The adjusted rate ratio comparing weekly rates of unplanned hospital days during the 2 years after versus before tube placement was 0.92 (95% CI: 0.57-1.48). Similarly, rates of reflux-related hospital days, emergency department visits, and outpatient visits were unchanged. Unplanned hospital days were stable within subgroups, although rates across subgroups varied.
Mortality is high among children with NI after feeding tube placement. However, the stability of health care use before and after the procedure suggests that the high mortality may reflect underlying fragility rather than increased risk from nonoral feeding. Further research to inform risk stratification and prognostic accuracy is needed.
患有神经功能障碍（NI）的儿童常因营养不良或吸入而进行饲管置放。我们评估了该人群在置管后的生存情况和急性医疗保健使用情况。
这是一项基于人群的暴露交叉研究，我们使用了来自加拿大安大略省的链接行政数据。我们确定了 1993 年至 2015 年间患有 NI 并接受初次胃造口术或胃空肠造口术置管的 13 个月至 17 岁儿童。我们从手术到死亡或最后一次临床就诊的时间确定了生存时间，并计算了总体和与反流相关的诊断、急诊就诊和门诊就诊的无计划住院天数的每周平均率。率比通过负二项式广义估计方程模型进行估计，该模型调整了时间和年龄。
饲管置放后 2 年的生存率为 87.4%（95%置信区间[CI]：85.2%-89.4%），5 年生存率为 75.8%（95% CI：72.8%-78.4%）。与置管前相比，调整后的 2 年与置管后每周无计划住院天数的比率比为 0.92（95% CI：0.57-1.48）。同样，与反流相关的住院天数、急诊就诊和门诊就诊的比率也没有变化。尽管亚组之间的比率有所不同，但无计划住院天数在亚组内保持稳定。
在接受饲管置放后，患有 NI 的儿童死亡率较高。然而，在该程序前后医疗保健使用的稳定性表明，高死亡率可能反映了基础脆弱性，而不是非口服喂养的风险增加。需要进一步研究以确定风险分层和预测准确性。
