| Study Type | Domain | Description of Applicability of Evidence |
|---|---|---|
| Studies Including Individuals Without Significant Presurgical Reflux | Population | Studies included children between the ages of roughly 5 months to 18 years with typically severe motor impairment (majority with GMFCS levels of IV or V) and oral-motor dysfunction; one study assessed caregiver stress (children of caregivers were median age 4 years with GMFCS level IV or V; caregivers were typically mothers [77%]). |
| Intervention | Intervention included placement of a gastrostomy tube (gastrostomy, gastrojejunostomy, PEG, gastrostomy plus fundoplication). Participants were typically followed for 6 to 12 months post-surgery. | |
| Comparators | The comparator in one cohort study was oral feeding. | |
| Outcomes | Outcomes assessed included measures of growth (weight, height, leg length, skinfold thickness), fat mass/fat-free mass, micronutrient status, episodes of GER, chest infections, hospitalizations, QOL (child and caregiver), caregiver stress/satisfaction, feeding time, energy expenditure, harms, and mortality. | |
| Setting | Settings included specialist feeding clinics and children's hospitals in Canada, Brazil, the United Kingdom, Australia, and the United States. | |
| Studies Including Individuals With Presurgical Reflux | Population | Children (age range: 3 months–13 years) with largely mixed or spastic CP and GERD. |
| Intervention | One RCT and one case series assessed Nissen fundoplication (with gastrostomy in the majority of cases); procedures were both open and laparoscopic. | |
| Comparators | The RCT compared Nissen fundoplication with vertical gastric plication. | |
| Outcomes | Outcomes assessed included reflux episodes (#, duration, and pH), weight, length of stay, surgical duration, respiratory symptoms, harms, and mortality. | |
| Setting | Patients were recruited from hospitals in Brazil and China. |
CP = cerebral palsy; GER = gastroesophageal reflux; PEG = percutaneous endoscopic gastrostomy; RCT = randomized controlled trial
From: Discussion
NCBI Bookshelf. A service of the National Library of Medicine, National Institutes of Health.