Aim Identify criteria to guide decision making for gastrostomy insertion in a population of children with a neurodisability.
Methods All children with a gastrostomy in-situ in 2016 were identified. Forty two children with a neurodisability were included, thirty two children were excluded due to other medical diagnoses and insufficient data.
Data was collected retrospectively from medical records looking at the decision making around gastrostomy insertion.
This data was compared with criteria from Practical Approach to Paediatric Enteral Nutrition: a comment by the ESPGHAN committee on nutrition. JPGN.vol 51 (1)2010. The ESPGHAN clinical practice guide was used as a standard because of its objective and paediatric specific criteria.
Results Thirty three cases were preschool aged and nine cases were school aged children. The most common diagnoses were cerebral palsy and chromosomal conditions. All conditions met ESPGHAN’s indications for gastrostomy insertion.
Comparison of data to ESPGHAN guidance showed: thirty three cases had insufficient oral intake; sixteen cases had wasting and stunting. In the latter group nine children over two years had weight loss or no weight gain for a period of over three months; four children under two years had inadequate growth or weight gain for greater than one month and three children dropped two centiles on the growth charts.
The decision to insert a gastrostomy was made by eight different teams, a nutrition team approach wasn’t often adopted.
Conclusion The decision to insert a gastrostomy is challenging for both professionals and parents.
Most children with gastrostomies were those with insufficient oral intake, this was difficult to quantify with the ESPGHAN guide. Medical information such as unsafe swallow or nasogastric tube dependence was used to categorise this group. Many of these children were sufficiently nourished.
Fewer children demonstrated wasting and stunting. Growth faltering is a concern to professionals and appropriate action is needed.
Parental agreement to a gastrostomy can be difficult in all these cases. The audit aims to produce guidance on clinical need for gastrostomy insertion specific to children with a neurodisability. The guidance will create a pathway of care which will be implemented through a multidisciplinary nutrition support team.