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  • 1.
    Backman, Ellen
    et al.
    Högskolan i Halmstad, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Karlsson, Ann-Kristin
    Department of Research and Development, Region Halland, Halmstad, Sweden.
    Sjögreen, Lotta
    Mun-H-Center Orofacial Resource Center for Rare Diseases, Public Dental Service, Gothenburg, Sweden.
    Gastrostomy tube feeding in children with developmental or acquired disorders: A longitudinal comparison on health care provision, and eating outcomes four years after gastrostomy2018In: Nutrition in clinical practice, ISSN 0884-5336, Vol. 33, no 4, p. 576-583Article in journal (Refereed)
    Abstract [en]

    Background: Studies on long‐term feeding and eating outcomes in children requiring gastrostomy tube feeding (GT) are scarce. The aim of this study was to describe children with developmental or acquired disorders receiving GT and to compare longitudinal eating and feeding outcomes. A secondary aim was to explore healthcare provision related to eating and feeding.

    Methods: This retrospective cohort study reviewed medical records of children in 1 administrative region of Sweden with GT placement between 2005 and 2012. Patient demographics, primary diagnoses, age at GT placement, and professional healthcare contacts prior to and after GT placement were recorded and compared. Feeding and eating outcomes were assessed 4 years after GT placement.

    Results: The medical records of 51 children, 28 boys and 23 girls, were analyzed and grouped according to “acquired” (n = 13) or “developmental” (n = 38) primary diagnoses. At 4 years after GT placement, 67% were still using GT. Only 6 of 37 (16%) children with developmental disorders transferred to eating all orally, as opposed to 10 of 11 (91%) children with acquired disorders. Children with developmental disorders were younger at the time of GT placement and displayed a longer duration of GT activity when compared with children with acquired disorders.

    Conclusions: This study demonstrates a clear difference between children with developmental or acquired disorders in duration of GT activity and age at GT placement. The study further shows that healthcare provided to children with GT is in some cases multidisciplinary, but primarily focuses on feeding rather than eating.

  • 2.
    Backman, Ellen
    et al.
    Högskolan i Halmstad, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Karlsson, Ann-Kristin
    Department of Research and Development, Region Halland, Halmstad, Sweden.
    Sjögreen, Lotta
    Mun-H-Center Orofacial Resource Center for Rare diseases, Gothenburg, Sweden.
    The use of gastrostomy in Swedish children – indications, and trends between 2005 and 20152017Conference paper (Refereed)
    Abstract [en]

    Children with complex medical needs requiring nutritional support are growing in number. This presentation will add new knowledge regarding gastrostomy in children by reporting primary diagnosis, and indications for the use of gastrostomy. Furthermore, the presentation will discuss and analyse data evolution trends from 2005 to 2015 in Sweden.

    Methods: The first part of the study used national statistics to provide a broad picture of gastrostomy use in Swedish children. The second part applied a retrospective observational study design, reviewing medical charts in order to obtain an in-depth picture of the children in need for gastrostomy, and its use in a five-year perspective.

    Results: The number of gastrostomy cases recorded in the national database was 3 946, 53% male, and 47% female. The distribution of age groups was: 0-4 years: 61% , 5-9 years: 17%, 10-14 years: 12%, and 15-19: years 10%.  When observing trends on a national level, the number of children receiving gastrostomy increased in average by 13% per year. Changes in the separate age groups were analysed. An increase was noted for children aged 0-4 years and for children aged 5-9 years. In the age groups 10-14 years and 15-19 years, there was no progressive increase. The results from the national statistics database will be discussed in relation to the medical chart-analyses of 75 children receiving gastrostomy in one Swedish administrative region between 2005 and 2015. 

    Conclusions: As in many parts of Europe, the number of children in need for gastrostomy is also growing in Sweden, with the youngest children seeming to be the group increasing most.

    Clinical implications: Nutritional support in Sweden is publicly financed, therefore these findings may be useful when planning both monetary and human resources in meeting the future challenges of paediatric health care.

  • 3.
    Backman, Ellen
    et al.
    Högskolan i Halmstad, Centrum för forskning om välfärd, hälsa och idrott (CVHI).
    Sjögreen, Lotta
    Orofacial Resource Centre for Rare Diseases, Public Dental Service, Mun-H-Center, Gothenburg, Sweden; Department of Health and Rehabilitation, Institute of Neuroscience and Physiology, Sahlgrenska Academy, Gothenburg, Sweden.
    Gastrostomy tube insertion in children with developmental or acquired disorders: a register-based study2020In: Developmental Medicine & Child Neurology, ISSN 0012-1622, E-ISSN 1469-8749, Vol. 62, no 10, p. 1191-1197Article in journal (Refereed)
    Abstract [en]

    AIM To describe trends in gastrostomy tube insertion in children with developmental or acquired disorders in Sweden and assess their demographic characteristics.

    METHOD Children aged 0 to 18 years with gastrostomy tube insertions recorded between 1998 and 2014 were identified in the Swedish National Patient Register. Associations between disorder type and year of surgery, as well as age at surgery, were analysed using linear regression analyses. The association between disorder type and mortality 2 years from gastrostomy tube insertion was also analysed using logistic regression analysis.

    RESULTS The data for 4112 children (2182 males, 1930 females), with a median age of 2 years (interquartile range=1–8y), were analysed. Children who presented with developmental disorders were the largest group (n=3501, 85%). The most common diagnosis in children with developmental disorders was cerebral palsy (n=165, 4%). In children with acquired disorders, acute lymphoblastic leukaemia (n=117, 3%) was the most common diagnosis. Gastrostomy tube insertions increased from 1998 to 2014, with the greatest increase in children with developmental disorders, who were younger than children with acquired disorders when the gastrostomy tube was first inserted. Age at tube insertion decreased inboth groups during the study period. Mortality was higher in children with acquired disorders, suggesting that gastrostomy tube insertion should be part of a palliative care approach.

    INTERPRETATION Child characteristics differed depending on whether the underlying disorder was developmental or acquired, suggesting a need for clinical health care guidelines related to the specific goals of gastrostomy tube insertion.

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