Safety of Appetite Manipulation in Children with Feeding Disorders Admitted to an Inpatient Feeding Program. J Pediatr Gastroenterol Nutr 2018 May;66(5):e127-e130
Date
12/07/2017Pubmed ID
29210920DOI
10.1097/MPG.0000000000001849Scopus ID
2-s2.0-85046734479 (requires institutional sign-in at Scopus site) 4 CitationsAbstract
OBJECTIVE: Appetite manipulation can be effective in weaning children off gastrostomy tube feeding dependence but can cause dehydration, hypoglycaemia, and ketone body production, which is anorexigenic. As the safety of this approach has not been described, our aim was to describe adverse events observed when weaning children from G-tube dependence using our appetite manipulation protocol.
METHODS: This was a retrospective study of prospectively collected data of patients who completed our inpatient tube-weaning protocol. Daily safety parameters included twice-daily urine specific gravities and urine ketones and fasting capillary blood glucose. Graded clinical interventions to manage adverse events were collected.
RESULTS: A total of 143 children with a mean age of 4.8 ± 2.4 years were seen in the inpatient feeding program of which 74 (51.7%) were male. The children were hospitalized 10.1 ± 2.5 days with the vast majority being discharged between days 11 and 14. Overall, 78.2% of patients experienced at least 1 adverse event: urine specific gravity >1.020 was seen in 60.5%, ketonuria in 48.9%, and hypoglycemia (≤60 mg/dL) in 13.4%. Only 2 children had blood glucose levels <40 mg/dL and these were corrected with oral supplementation. Graded clinical interventions to manage adverse events included oral rehydration in 89.9% of children and supplemental tube feeding in 25.2%.
CONCLUSIONS: Adverse effects are common when appetite manipulation is used to wean children off G-tube dependence. Anticipating, monitoring, and having a clear intervention plan in a closely monitored setting are necessary to safely use this method.
Author List
Pollow AS, Karls CA, Witzlib M, Noel RJ, Goday PS, Silverman AHAuthor
Alan Silverman PhD Professor in the Pediatrics department at Medical College of WisconsinMESH terms used to index this publication - Major topics in bold
AppetiteBlood Glucose
Child
Child, Preschool
Enteral Nutrition
Feeding Behavior
Feeding and Eating Disorders
Female
Humans
Hypoglycemia
Inpatients
Ketosis
Male
Monitoring, Physiologic
Retrospective Studies
Specific Gravity
Urinalysis
