Optimizing Nutrition in Pediatric Neuromuscular Disorders: The Role of Percutaneous Endoscopic Gastrostomy

Aims Enteral nutrition (EN) has emerged as a pivotal intervention in managing the nutritional needs of pediatric patients with neuromuscular and neurological diseases. These conditions often lead to significant challenges in oral intake, necessitating an effective and safe alternative to ensure adequate nutrition. When long-term nutrition is required, current medical guidelines recommend the use of a gastrostomy or enterostomy tube to maintain nutritional support. The primary aim of our study is to assess the effect of PEG on the nutritional status of pediatric patients with rare neuromuscular and neurological disorders, while the secondary objective is to evaluate the incidence and severity of related complications.

Methods Retrospective study, conducted at a tertiary care center. Inclusion criteria were patients under 18 years diagnosed with neuromuscular and neurological diseases, requiring PEG for long-term nutrition. Demographic, clinical, laboratory, and endoscopic data were systematically collected at the time of the PEG procedure, as well as at 3-, 6-, and 12-months post-operation, and annually during follow-up until last follow-up. Growth parameters and nutritional markers were monitored, with z-scores for weight, height, and BMI calculated using World Health Organization standards.

Results The cohort comprised 40 pediatric patients, with a median age of 17 months (IQR 7-153). The most prevalent diagnosis was Spinal Muscular Atrophy, followed by Duchenne Muscular Dystrophy and other less prevalent neurological diseases. Over a median follow-up of 35.5 months (IQR 349.5-1541.5), significant nutritional improvements were observed in children over 2 years (table 1). Laboratory findings supported these outcomes, showing increased hemoglobin at all measured intervals and improved albumin levels at the 6-month evaluation (table 2). Three patients (7.5%) required a transition to a Gastro-jejunal tube due to the development of gastroesophageal reflux disease. There were three (7.5%) major adverse events associated with the endoscopic procedure: two cases (5%) of buried bumper syndrome and one (2.5%) translocation of the internal bumper to the transverse colon.

Conclusions The study demonstrates the effectiveness and safety of PEG in enhancing nutritional outcomes among pediatric patients, particularly those with rare neuromuscular and neurological conditions, with marked benefits observed in those aged over 2 years.

Publication History

Article published online:
15 April 2024