Abstract

Objective: Identifying complications related to enteral nutrition at home in children is important in terms of establishing standard discharge education and training programs to support parents in managing complications. The study aimed to synthesize current evidence on the complications of pediatric enteral nutrition at home.

Methods: The study was conducted according to PRISMA recommendations. Eight databases were reviewed between 2012 and 2022 in Turkish, German, and English languages. Articles were assessed in three stages: title, abstract, and full text. The review included 18 studies that met all the inclusion criteria. The Joanna Briggs Institute Meta-Analysis of Statistics Assessment and Review Instruments were used to assess the quality appraisal of the studies.

Results: A total of 18 studies with 19,531 children were included from 14 countries. The outcome measures were major and minor complications with pediatric enteral nutrition at home. 11 of the 18 papers included were retrospective studies on complications of PEG. In studies reporting the overall rate of major complications ranged from 0% to 14.3%, and the most common complications were reoperation (2.64%-12.4%), and gastrocolic fistula/perforation (0.9%-3.8%). In studies reporting the overall rate of minor complications, the rate ranged from 16.4%-73.6% and the most common complications were infection (8.2%-31.9%), dislodgement (1.6%-21%), skin granulation (4%-50.4%), and vomiting (1%-49.89%).

Conclusion: This systematic review reveals that the rate of complications in pediatric enteral nutrition at home cannot be underestimated. Healthcare providers should plan their practice considering these complications to support parents in managing complications of pediatric enteral nutrition at home.

Keywords: Complications, home enteral nutrition, enteral feeding, children

Copyright and license

Copyright © 2024 The author(s). This is an open-access article under the terms of the Creative Commons Attribution License (CC BY) which permits unrestricted use, distribution, and reproduction in any medium or format, provided the original work is properly cited.

How to cite

1.
Semerci R, Pars H. Complications of pediatric enteral nutrition at home: a systematic review of quantitative research. Clin Sci Nutr. 2024;6(1):27-42. doi:10.62210/ClinSciNutr.2024.80

References

  1. Bawazir O, Banaja AM, Bawazir R, Bawazir AO. Percutaneous endoscopic gastrostomy in children: A tertiary center experience. Asian J Endosc Surg. 2022;15:524-530. https://doi.org/10.1111/ases.13040
  2. Volpe A, Malakounides G. Feeding tubes in children. Curr Opin Pediatr. 2018;30:665-670. https://doi.org/10.1097/MOP.0000000000000666
  3. Balogh B, Kovács T, Saxena AK. Complications in children with percutaneous endoscopic gastrostomy (PEG) placement. World J Pediatr. 2019;15:12-16. https://doi.org/10.1007/s12519-018-0206-y
  4. Edwards ST, Glynn EF, Slogic M, et al. Demographics of children with feeding difficulties from a large electronic health record database. JPEN J Parenter Enteral Nutr. 2022;46:1022-1030. https://doi.org/10.1002/jpen.2379
  5. Kovacic K, Rein LE, Szabo A, Kommareddy S, Bhagavatula P, Goday PS. Pediatric Feeding Disorder: A Nationwide Prevalence Study. J Pediatr. 2021;228:126-131.e3. https://doi.org/10.1016/j.jpeds.2020.07.047
  6. Benjasuwantep B, Chaithirayanon S, Eiamudomkan M. Feeding problems in healthy young children: prevalence, related factors and feeding practices. Pediatr Rep. 2013;5:38-42. https://doi.org/10.4081/pr.2013.e10
  7. Braegger C, Decsi T, Dias JA, et al. Practical approach to paediatric enteral nutrition: a comment by the ESPGHAN committee on nutrition. J Pediatr Gastroenterol Nutr. 2010;51:110-122. https://doi.org/10.1097/MPG.0b013e3181d336d2
  8. Feeding Tube Awareness Foundation. Conditions that can require tube feeding in children. Available at: https://www.feedingtubeawareness.org/condition-list (Accessed on 21 May, 2022).
  9. Bischoff SC, Austin P, Boeykens K, et al. ESPEN practical guideline: Home enteral nutrition. Clin Nutr. 2022;41:468-488. https://doi.org/10.1016/j.clnu.2021.10.018
  10. Homan M, Hauser B, Romano C, et al. Percutaneous Endoscopic Gastrostomy in Children: An Update to the ESPGHAN Position Paper. J Pediatr Gastroenterol Nutr. 2021;73:415-426. https://doi.org/10.1097/MPG.0000000000003207
  11. Gao X, Zhang Y, Zhang L, et al. Effect of Home Enteral Nutrition on Nutritional Status, Body Composition and Quality of Life in Patients With Malnourished Intestinal Failure. Front Nutr. 2021;8:643907. https://doi.org/10.3389/fnut.2021.643907
  12. Wiernicka A, Matuszczyk M, Szlagatys-Sidorkiewicz A, et al. Analysis of frequency and risk factors for complications of enteral nutrition in children in Poland after percutaneous endoscopic gastrostomy placement. Nutrition. 2021;89:111265. https://doi.org/10.1016/j.nut.2021.111265
  13. Piening N, Osei H, Munoz Abraham AS, Piening A, Greenspon J, Villalona GA. Open Gastrostomy Tube Placement is Associated With Higher Complications in Infants: A National Surgical Quality Improvement Program Database Analysis. J Surg Res. 2021;260:345-349. https://doi.org/10.1016/j.jss.2020.10.033
  14. Arca MJ, Rangel SJ, Hall M, et al. Case Volume and Revisits in Children Undergoing Gastrostomy Tube Placement. J Pediatr Gastroenterol Nutr. 2017;65:232-236. https://doi.org/10.1097/MPG.0000000000001523
  15. Naiditch JA, Lautz T, Barsness KA. Postoperative complications in children undergoing gastrostomy tube placement. J Laparoendosc Adv Surg Tech A. 2010;20:781-785. https://doi.org/10.1089/lap.2010.0191
  16. Weszelits SM, Ridosh MM, O'Connor A. Displaced Gastrostomy Tube in the Pediatric Emergency Department: Implementing an Evidence-based Algorithm and Quality Improvement Project. J Emerg Nurs. 2021;47:113-122. https://doi.org/10.1016/j.jen.2020.09.007
  17. Suluhan D, Yildiz D, Surer I, Fidanci Eren B, Balamtekin N. Effect of Gastrostomy Tube Feeding Education on Parents of Children with Gastrostomy. Nutr Clin Pract. 2021;36:1220-1229. https://doi.org/10.1002/ncp.10586
  18. Mohamed Elfadil O, Ewy M, Patel J, Patel I, Mundi MS. Growing use of home enteral nutrition: a great tool in nutrition practice toolbox. Curr Opin Clin Nutr Metab Care. 2021;24:446-452. https://doi.org/10.1097/MCO.0000000000000777
  19. Pars H, Soyer T. Home Gastrostomy Feeding Education Program: Effects on the Caregiving Burden, Knowledge, and Anxiety Level of Mothers. JPEN J Parenter Enteral Nutr. 2020;44:1029-1037. https://doi.org/10.1002/jpen.1747
  20. Moher D, Shamseer L, Clarke M, et al. Preferred reporting items for systematic review and meta-analysis protocols (PRISMA-P) 2015 statement. Syst Rev. 2015;4:1. https://doi.org/10.1186/2046-4053-4-1
  21. Page MJ, McKenzie JE, Bossuyt PM, et al. The PRISMA 2020 statement: An updated guideline for reporting systematic reviews. Int J Surg. 2021;88:105906. https://doi.org/10.1016/j.ijsu.2021.105906
  22. Eriksen MB, Frandsen TF. The impact of patient, intervention, comparison, outcome (PICO) as a search strategy tool on literature search quality: a systematic review. J Med Libr Assoc. 2018;106:420-431. https://doi.org/10.5195/jmla.2018.345
  23. Richardson WS, Wilson MC, Nishikawa J, et al. The well-built clinical question: a key to evidence-based decisions. ACP J Club. 1995;123:A12-A13. https://doi.org/10.7326/ACPJC-1995-123-3-A12
  24. Tufanaru C, Munn Z, Aromataris E, Campbell J, Hopp L. Systematic reviews of effectiveness. In: Aromataris E, Munn Z, editors. Joanna Briggs Institute Reviewer's Manual. The Joanna Briggs Institute; 2020: chap 3. https://doi.org/10.46658/JBIRM-17-03
  25. Moola S, Munn Z, Sears K, et al. Conducting systematic reviews of association (etiology): The Joanna Briggs Institute's approach. Int J Evid Based Healthc. 2015;13:163-169. https://doi.org/10.1097/XEB.0000000000000064
  26. Goldsmith MR, Bankhead CR, Austoker J. Synthesising quantitative and qualitative research in evidence-based patient information. J Epidemiol Community Health. 2007;61:262-270. https://doi.org/10.1136/jech.2006.046110
  27. Landisch RM, Colwell RC, Densmore JC. Infant gastrostomy outcomes: The cost of complications. J Pediatr Surg. 2016;51:1976-1982. https://doi.org/10.1016/j.jpedsurg.2016.09.025
  28. McSweeney ME, Kerr J, Jiang H, Lightdale JR. Risk factors for complications in infants and children with percutaneous endoscopic gastrostomy tubes. J Pediatr. 2015;166:1514-1519.e1. https://doi.org/10.1016/j.jpeds.2015.03.009
  29. Khalil ST, Uhing MR, Duesing L, Visotcky A, Tarima S, Nghiem-Rao TH. Outcomes of Infants With Home Tube Feeding: Comparing Nasogastric vs Gastrostomy Tubes. JPEN J Parenter Enteral Nutr. 2017;41:1380-1385. https://doi.org/10.1177/0148607116670621
  30. Kidder M, Phen C, Brown J, et al. Effectiveness and Complication Rate of Percutaneous Endoscopic Gastrostomy Placement in Pediatric Oncology Patients. Pediatr Gastroenterol Hepatol Nutr. 2021;24:546-554. https://doi.org/10.5223/pghn.2021.24.6.546
  31. Krom H, van Zundert SMC, Otten MAGM, van der Sluijs Veer L, Benninga MA, Kindermann A. Prevalence and side effects of pediatric home tube feeding. Clin Nutr. 2019;38:234-239. https://doi.org/10.1016/j.clnu.2018.01.027
  32. Ronning MM, Gaillard P, Wey A, Roback MG. Comparison of Emergency Department Visits for Complications of Gastrostomy Versus Gastrojejunostomy Tubes in Children. Pediatr Emerg Care. 2017;33:e71-e74. https://doi.org/10.1097/PEC.0000000000001267
  33. Pahsini K, Marinschek S, Khan Z, Dunitz-Scheer M, Scheer PJ. Unintended Adverse Effects of Enteral Nutrition Support: Parental Perspective. J Pediatr Gastroenterol Nutr. 2016;62:169-173. https://doi.org/10.1097/MPG.0000000000000919
  34. Goldin AB, Heiss KF, Hall M, et al. Emergency Department Visits and Readmissions among Children after Gastrostomy Tube Placement. J Pediatr. 2016;174:139-145.e2. https://doi.org/10.1016/j.jpeds.2016.03.032
  35. Mason CA, Skarda DE, Bucher BT. Outcomes After Laparoscopic Gastrostomy Suture Techniques in Children. J Surg Res. 2018;232:26-32. https://doi.org/10.1016/j.jss.2018.05.022
  36. Hajjat T, Rahhal RM. Differences in Durability, Dislodgement, and Other Complications With Use of Low-Profile Nonballoon Gastrostomy Tubes in Children. Nutr Clin Pract. 2017;32:219-224. https://doi.org/10.1177/0884533616680356
  37. Franken J, Mauritz FA, Suksamanapun N, Hulsker CC, van der Zee DC, van Herwaarden-Lindeboom MY. Efficacy and adverse events of laparoscopic gastrostomy placement in children: results of a large cohort study. Surg Endosc. 2015;29:1545-1552. https://doi.org/10.1007/s00464-014-3839-5
  38. Sakamoto S, Hashizume N, Fukahori S, et al. Complications in patients with neurological impairment after gastrostomy. Pediatr Int. 2021;63:1357-1362. https://doi.org/10.1111/ped.14645
  39. Khdair Ahmad F, Younes D, Al Darwish MB, Aljubain MA, Dweik M, Alda'as Y. Safety and outcomes of percutaneous endoscopic gastrostomy tubes in children. Clin Nutr ESPEN. 2020;38:160-164. https://doi.org/10.1016/j.clnesp.2020.05.011
  40. Fascetti-Leon F, Gamba P, Dall'Oglio L, et al. Complications of percutaneous endoscopic gastrostomy in children: results of an Italian multicenter observational study. Dig Liver Dis. 2012;44:655-659. https://doi.org/10.1016/j.dld.2012.03.017
  41. Işık İA, Akbulut UE, Atalay A, et al. Complications of percutaneous endoscopic gastrostomy in children: a single centre experience. J Pediatr Res. 2021;8:377-381. https://doi.org/10.4274/jpr.galenos.2020.15679
  42. Di Leo G, Pascolo P, Hamadeh K, et al. Gastrostomy Placement and Management in Children: A Single-Center Experience. Nutrients. 2019;11:1555. https://doi.org/10.3390/nu11071555
  43. Hansen E, Qvist N, Rasmussen L, Ellebaek MB. Postoperative complications following percutaneous endoscopic gastrostomy are common in children. Acta Paediatr. 2017;106:1165-1169. https://doi.org/10.1111/apa.13865
  44. Friedman JN, Ahmed S, Connolly B, Chait P, Mahant S. Complications associated with image-guided gastrostomy and gastrojejunostomy tubes in children. Pediatrics. 2004;114:458-461. https://doi.org/10.1542/peds.114.2.458
  45. Frank C, Williams RF, Boulden T, Kink R, Paton EA. Ultrasound is safe and highly specific for confirmation of proper gastrostomy tube replacement in pediatric patients. J Pediatr Surg. 2022;57:390-395. https://doi.org/10.1016/j.jpedsurg.2022.01.024
  46. Schweitzer M, Aucoin J, Docherty SL, Rice HE, Thompson J, Sullivan DT. Evaluation of a discharge education protocol for pediatric patients with gastrostomy tubes. J Pediatr Health Care. 2014;28:420-428. https://doi.org/10.1016/j.pedhc.2014.01.002