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Perspective on the paper by Sullivan et al (see page 478)
In this issue, Sullivan et al report on their findings of a study of gastrostomy feeding in children with cerebral palsy.1 This study is part of a larger examination of the impact of this intervention on children. Their key findings are that there is no increase in respiratory morbidity following gastrostomy insertion and indeed a reduced need for antibiotics or hospital admission in the 12 months following the procedure for children with cerebral palsy. As they point out, there are a number of reports in the literature that have suggested the reverse finding, an increase in mortality following gastrostomy. A recent systematic review highlighted the continued paucity of evidence on the risks and benefits of this intervention, in particular noting an excess of deaths in the gastrostomy fed group with cerebral palsy, observing however that this may reflect differing levels of disability in the intervention and control groups.2
Clearly there are risks in any surgical procedure, but this paper goes some way to provide reassurance that the medical risks are small. This paper is therefore useful in providing further information for professionals working with children and families to be clearer about the biomedical risks and benefits of this procedure.
This study reports on experience in specialist multidisciplinary feeding clinics for children with neurological disabilities which is likely to mean that they are reporting on best practice. In general, concentration of expertise and resources in specialist centres results in improved outcomes, but we need to be cautious about …