Impact of fundoplication versus gastrojejunal feeding tubes on mortality and in preventing aspiratiion pneumonia in young children with neurologic impairment who have gastroesophageal reflux disease
Srivastava, Rajendu Downey, Earl C. O'Gorman, Molly Feola, Peter Samore, Matthew Holubkov, Richard Mundorff, Michael James, Brent C. Rosenbaum, Peter Young, Paul C.
Srivastava, Rajendu
Downey, Earl C.
O'Gorman, Molly
Feola, Peter
Samore, Matthew
Holubkov, Richard
Mundorff, Michael
James, Brent C.
Rosenbaum, Peter
Young, Paul C.
Abstract
Objective: Aspiration pneumonia is the most common cause of death in children with neurologic impairment who have gastroesophageal reflux disease. Fundoplications and gastrojejunal feeding tubes are frequently employed to prevent aspiration pneumonia in this population. Which of these approaches is more effective in preventing aspiration pneumonia and/or improving survival is unknown. The objective of this study was to compare outcomes for children with neurologic impairment and gastroesophageal reflux disease after either a first fundoplication or a first gastrojejunal feeding tube. Patients and methods: This was a retrospective, observational cohort study of children with neurologic impairment who had either a fundoplication or gastrojejunal feeding tube between January 1997 and December 2005 at a tertiary care children's hospital. Main outcome measures were postprocedure aspiration pneumonia–free survival and mortality. Propensity analyses were used to control for bias in treatment assignment and prognostic imbalances. Results: Of the 366 children with neurologic impairment and gastroesophageal reflux disease, 43 had a first gastrojejunal feeding tube and 323 underwent a first fundoplication. Median length of follow-up was 3.4 years. Children who received a first fundoplication had similar rates of aspiration pneumonia and mortality after the procedure compared with those who had a first gastrojejunal feeding tube, when adjusting for the treatment assignment using propensity scores. Conclusions: Aspiration pneumonia and mortality are not uncommon events after either a first fundoplication or a first gastrojejunal feeding tube for the management of gastroesophageal reflux disease in children with neurologic impairment. Neither treatment option is clearly superior in preventing the subsequent aspiration pneumonia or improving overall survival for these children. This complex clinical scenario needs to be studied in a prospective, multicenter, randomized control trial to evaluate definitively whether 1 of these 2 management options is more beneficial.
Keywords
children, neurologic impairment, gastroesophageal reflux disease, aspiration pneumonia, fundoplication
Date
2009
Type
Journal article
Journal
Pediatrics
Book
Volume
123
Issue
1
Page Range
338-345
Article Number
ACU Department
Collections
Relation URI
Source URL
Event URL
Open Access Status
Open access