Division of Pediatric Hospital Medicine, Department of Pediatrics, 14434University of Utah School of Medicine, Salt Lake City, UT, USA.
Department of Biostatistics and Data Science, 12279Wake Forest School of Medicine, Winston-Salem, NC, USA.
J Child Neurol. 2021 Aug;36(9):727-734. doi: 10.1177/08830738211000179. Epub 2021 Mar 22.
Gastrostomy tube (G-tube) placement for children with neurologic impairment with dysphagia has been suggested for pneumonia prevention. However, prior studies demonstrated an association between G-tube placement and increased risk of pneumonia. We evaluate the association between timing of G-tube placement and death or severe pneumonia in children with neurologic impairment.
We included all children enrolled in California Children's Services between July 1, 2009, and June 30, 2014, with neurologic impairment and 1 pneumonia hospitalization. Prior to analysis, children with new G-tubes and those without were 1:2 propensity score matched on sociodemographics, medical complexity, and severity of index hospitalization. We used a time-varying Cox proportional hazard model for subsequent death or composite outcome of death or severe pneumonia to compare those with new G-tubes vs those without, adjusting for covariates described above.
A total of 2490 children met eligibility criteria, of whom 219 (9%) died and 789 (32%) had severe pneumonia. Compared to children without G-tubes, children with new G-tubes had decreased risk of death (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.39-0.55) but increased risk of the composite outcome (HR 1.21, CI 1.14-1.27). Sensitivity analyses using varied time criteria for definitions of G-tube and outcome found that more recent G-tube placement had greater associated risk reduction for death but increased risk of severe pneumonia.
Recent G-tube placement is associated with reduced risk of death but increased risk of severe pneumonia. Decisions to place G-tubes for pulmonary indications in children with neurologic impairment should weigh the impact of severe pneumonia on quality of life.
对于有吞咽困难的神经功能障碍儿童，胃造口管（G 管）的放置被建议用于预防肺炎。然而，先前的研究表明 G 管放置与肺炎风险增加之间存在关联。我们评估了神经功能障碍儿童 G 管放置时机与死亡或严重肺炎之间的关系。
我们纳入了 2009 年 7 月 1 日至 2014 年 6 月 30 日期间在加利福尼亚儿童服务中心登记的所有有神经功能障碍和 1 次肺炎住院的儿童。在分析之前，根据社会人口统计学、医疗复杂性和指数住院严重程度，对新置 G 管和未置 G 管的儿童进行 1:2 的倾向评分匹配。我们使用时间相关 Cox 比例风险模型比较新置 G 管和未置 G 管的儿童随后死亡或死亡或严重肺炎的复合结局，调整了上述协变量。
共有 2490 名儿童符合入选标准，其中 219 名（9%）死亡，789 名（32%）患有严重肺炎。与未置 G 管的儿童相比，新置 G 管的儿童死亡风险降低（风险比[HR]0.47，95%置信区间[CI]0.39-0.55），但复合结局的风险增加（HR 1.21，CI 1.14-1.27）。使用不同的 G 管和结局定义时间标准进行敏感性分析发现，最近的 G 管放置与死亡风险降低相关，但严重肺炎的风险增加。
最近的 G 管放置与死亡风险降低相关，但严重肺炎的风险增加。对于有神经功能障碍的儿童，为肺部适应症放置 G 管的决定应权衡严重肺炎对生活质量的影响。
