UCL Great Ormond Street Institute of Child Health, University College London, London, WC1N 3JH, UK.
Department of Pediatrics, College of Medicine, King Saud University, King Saud University Medical City, Riyadh, Saudi Arabia.
Pediatr Nephrol. 2024 Oct;39(10):3049-3056. doi: 10.1007/s00467-024-06277-w. Epub 2024 Feb 13.
Gastrostomy tube (GT) feeding is used to promote nutrition and growth in children with chronic kidney disease (CKD). We explored the relationship between gastrostomy feeding and growth parameters in children with CKD, looking specifically at the nutritional composition of feeds.
Children with CKD stages 3-5 or on dialysis in a tertiary children's kidney unit were studied. Data on anthropometry, biochemistry, and nutritional composition of feeds were collected from the time of GT insertion for 3 years or until transplantation.
Forty children (18 female) were included. Nineteen children were on peritoneal dialysis, 8 on hemodialysis, and 13 had CKD stages 3-5. The median (interquartile range [IQR]) age at GT insertion was 1.26 (0.61-3.58) years, with 31 (77.5%) under 5 years of age. The median duration of gastrostomy feeding was 5.32 (3.05-6.31) years. None received growth hormone treatment. Children showed a significant increase in weight standard deviation score (SDS) (p = 0.0005), weight-for-height SDS (p = 0.0007) and body mass index (BMI) SDS (p < 0.0001). None of the children developed obesity. Although not statistically significant, the median height-SDS increased into the normal range (from -2.29 to -1.85). Weight-SDS positively correlated with the percentage of energy requirements from feeds (p = 0.02), and the BMI-SDS correlated with the percentage of total energy intake as fat (p < 0.001).
GT feeding improves weight-SDS and BMI-SDS without leading to obesity. GT feeding improved height-SDS but this did not reach statistical significance, suggesting that factors in addition to nutritional optimization need to be considered for statural growth.
胃造口管（GT）喂养用于促进慢性肾脏病（CKD）儿童的营养和生长。我们探讨了CKD 儿童胃造口喂养与生长参数之间的关系，特别关注喂养的营养成分。
研究对象为在三级儿童肾脏科接受治疗的 CKD 3-5 期或透析患儿。从 GT 插入开始的 3 年内或直至移植，收集儿童的人体测量学、生物化学和喂养营养成分的数据。
共纳入 40 名儿童（18 名女性）。19 名儿童接受腹膜透析，8 名儿童接受血液透析，13 名儿童患有 CKD 3-5 期。GT 插入时的中位（四分位间距 [IQR]）年龄为 1.26（0.61-3.58）岁，31 名（77.5%）儿童年龄小于 5 岁。GT 喂养的中位持续时间为 5.32（3.05-6.31）年。没有儿童接受生长激素治疗。儿童的体重标准差评分（SDS）（p=0.0005）、身高体重 SDS（p=0.0007）和体重指数（BMI）SDS（p<0.0001）均显著增加。没有儿童发生肥胖。虽然没有统计学意义，但身高 SDS 的中位数进入正常范围（从-2.29 到-1.85）。体重 SDS 与喂养所需能量百分比呈正相关（p=0.02），BMI SDS 与总能量摄入中脂肪百分比呈正相关（p<0.001）。
GT 喂养可改善体重 SDS 和 BMI SDS，而不会导致肥胖。GT 喂养改善了身高 SDS，但这没有达到统计学意义，表明除了营养优化外，还需要考虑其他因素来促进身高增长。
