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Neuropediatrics 2023; 54(06): 371-380
DOI: 10.1055/s-0043-1772708
Original Article

Nutritional Management in Children and Adolescents with Severe Neurological Impairment—Who Cares? A Web-Based Survey Among Pediatric Specialists in Germany

Sara Hommel   *
1   Department of Pediatric Gastroenterology, St. Josef Hospital, University Hospital of Pediatrics and Adolescent Medicine, Ruhr University, Bochum, Germany
,
T. Lücke
2   Department of Pediatric Neurology, St. Josef Hospital, University Hospital of Pediatrics and Adolescent Medicine, Ruhr University, Bochum, Germany
,
A. Schmidt-Choudhury
1   Department of Pediatric Gastroenterology, St. Josef Hospital, University Hospital of Pediatrics and Adolescent Medicine, Ruhr University, Bochum, Germany
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Abstract

Background Nutritional management of children and adolescents with severe neurological impairment (SNI) is challenging. A web-based survey was distributed to identify the present situation and the knowledge of the involved medical professionals in Germany.

Methods The survey was created with LimeSurvey, and access data were distributed by several medical societies. Eighty-three questions covered four topics: “general information,” “gastro- and jejunostomy procedure,” “handling of gastrostomies and feeding tubes,” and “nutritional management and follow-up of children and adolescents with SNI.” A descriptive analysis was performed with Microsoft Excel.

Results A total of 156 participated (65 completed and 91 partially), 27% being pediatric gastroenterologists, 23% pediatric neurologists, and 10% pediatric surgeons. The most common indications for gastrostomy and tube feeding were oropharyngeal dysfunction and failure to thrive. Many patients were still underweight after some months of enteral feeding. The procedure of gastrostomy and handling recommendations varied broadly. Frequently, standard operating procedures (SOPs) and written local guidelines did not exist, and there was a considerable request for training. Only 53% of participants were aware of the European Society for Paediatric Gastroenterology, Hepatology and Nutrition position paper published in 2017, even fewer (38%) followed the guidelines. The recommended measures to assess a nutritional status were often not respected.

Conclusion Nutritional management of children and adolescents with SNI in Germany is still strongly deficient. Despite the international guideline of 2017, few colleagues are aware of and adhere to the recommendations. This could be improved by interdisciplinary teaching and evaluation of the reasons for noncompliance. The procedure of gastrostomy and the patients' follow-up vary widely. Therefore, modified SOPs should be developed.

Keywords

neurological impairment - nutritional management - cerebral palsy

* This article is part of the thesis of Sara Hommel.




Publikationsverlauf

Eingereicht: 21. März 2023

Angenommen: 14. Juli 2023

Artikel online veröffentlicht:
22. August 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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