Weight and Length Increases in Children after Gastrostomy Placement

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Abstract

Objective To document catch-up growth in children in the first 18 months after gastrostomy surgery and characterize how weight and length growth differ according to medical and nutritional risks.

Design Repeated measures study to evaluate weight and linear growth in gastrostomy-fed children.

Subjects/setting Seventy-five subjects met the selection criteria: gastrostomy placement anytime from birth to age 6.5 years, diagnosis of failure to thrive before gastrostomy surgery, absence of nonmedical barriers to adequate nutrition. Children were seen in specialty outpatient clinics.

Outcome measures Three measurements of weight and length: at the time of surgery and 12 and 18 months after surgery.

Statistical analyses Paired t tests of z scores were used to determine catch-up growth. Analysis of variance used variables (age of placement, ambulatory status, prematurity, mode of feeding) to determine statistically significant predictors of growth.

Results After gastrostomy surgery, catch-up growth was observed in height and weight for children regardless of prematurity or age at the time of gastrostomy placement. Ambulatory children did not achieve catch-up growth, but nonambulatory children did. At 18 months after surgery, catch-up growth occurred in children whose sole source of nutrition was through the gastrostomy, as well as in those who were able to receive nutrition by mouth. Children with a diagnosis of cerebral palsy experienced better growth than children with other diagnoses.

Conclusion/application Failure to thrive in children up to age 6.5 years can be corrected when adequate nutrition is provided. Benefits of gastrostomy surgery observed in catch-up growth reinforce the importance of medical nutrition therapy. J Am Diet Assoc. 1996; 96: 874-879.

Section snippets

Methodolgy

The target population of this study included every gastros-tomy-fed child under the age of 8 years attending selected outpatient clinics staffed by University of Alabama at Birmingham faculty at The Children's Hospital of Alabama and the Alabama Department of Rehabilitation Services, Birmingham office. The study was approved by the University of Alabama Institutional Review Board. To be eligible for the study, gastrostomy placement had to have occurred any time from birth to 6.5 years of age,

Subject Description

The target population consisted of 130 children with gastros-tomies. Of these, 75 met all the criteria of the study and are characterized in Table 2, Table 3 and FIG 1, FIG 2. In this group of 75 children, three measurements were made on 40 subjects, two measurements on 24 subjects, and one measurement on 11 subjects. None of the subjects died or was lost to the study as a result of surgical complications in the 18 months after gastrostomy placement. The age at the time of gastrostomy placement

Discussion

This repeated measures design study demonstrated that catchup growth can be achieved by means of gastrostomy placement in children who were diagnosed with FTT before gastrostomy placement. The statistical method of the two-tail paired t test was consistent with that of Patrick et al (13). Our study confirmed the literature (5), (13), (14), (15), (16) that children with developmental disabilities often experience malnutrition and growth retardation, sometimes because of their underlying

Applications

Gastrostomy placement for achieving catch-up growth reinforces the importance of medical nutrition therapy. The results of this study support the correction of FTT in developmentally delayed children, up to age 6.5 years, when adequate nutrition is provided. Although the extent of height and weight increases were related to risk factors of prematurity, ambulation, and age, the increases were significantly greater than normal growth. Registered dietitians can reassure parents who are considering

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