Efficacy of gastrostomy feeding in infants and older children receiving chronic peritoneal dialysis.

OBJECTIVE: To assess the efficacy of supplemental gastrostomy tube (g-tube) feeding in infants and children receiving chronic peritoneal dialysis (CPD). DESIGN: Retrospective observational study. SETTING: Pediatric nephrology division of tertiary care center. PATIENTS: Fifteen patients undergoing g-tube insertion while receiving CPD were included in the study, and were subdivided, on the basis of age, into the following groups: infants (< or = 2.5 years, n = 8); older children (> 2.5 years, n = 7). MAIN OUTCOME MEASURES: Assessment of the effect of CPD and g-tube feeding on statural growth assessed by height standard deviation score (SDS) and percentage weight-for-height, and measured anthropometric variables including triceps skinfold thickness (TSF), midarm muscle circumference (MAMC), and midarm mean circumference (MAC). Assessment of the effects of CPD and g-tube feeding on measured biochemical variables including total protein, albumin, cholesterol, triglycerides, and high density lipoprotein. RESULTS: No significant change in height SDS was observed; however, the reported continuing decline in height SDS in infants was arrested. Percentage weight-for-height increased significantly in infants at 6 months (p = 0.008) and 12 months (p = 0.006) following initiation of g-tube feeding. An increase was also observed in the older child group, being significant at 12 months (p = 0.031) following g-tube insertion. Increases in all anthropometric variables occurred in the infant group during CPD and post g-tube insertion, significant only for MAMC at 12 months (p = 0.037) post g-tube insertion. In older children little change occurred during CPD, with all variables increasing post g-tube insertion, significant only for MAMC at 6 months (p = 0.02) and 12 months (p = 0.02). An increase in total protein and albumin was noted; however, no significant changes in any biochemical parameters were observed. CONCLUSIONS: Supplemental g-tube feeding facilitates weight gain in infants and older children receiving CPD and arrests the decline in height SDS traditionally observed in infants with end-stage renal disease. No significant alteration was observed in measured biochemical variables, although an increase in total protein and albumin was noted.

Decrease in gastric emptying time and episodes of regurgitation in children with spastic quadriplegia fed a whey-based formula.

The gastric emptying times associated with three whey-based formulas were significantly shorter than that associated with a casein-based formula in nine gastrostomy-fed patients with spastic quadriplegia (p less than 0.001). Patients fed whey-based formulas had significantly fewer episodes of emesis than when they were fed casein-based formula (p less than 0.001). We conclude that whey-based formulas reduce the frequency of emesis by improving the rate of gastric emptying.

Tube feeding in children on chronic peritoneal dialysis.

We feel that tube feeding children on CPD is an important and useful therapy to optimize their growth. Strategies to accelerate growth in such children by using human growth hormone are interesting and await scientific confirmation with controlled trials.