Major complications of jejunal feeding in children
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In brief
In brief
Retrospective study of 197 pediatric patients receiving jejunal feeding found a 6.1% risk of major surgical complications, including bowel ischemia (3.6%), intussusception, and volvulus, with 2 deaths. Most affected patients were neurologically impaired with comorbidities, highlighting the need for careful risk counseling before initiating jejunal feeding.
Written by the GCMD Library team from the article.
Aim of the study
The aim of the study was to identify major gastrointestinal complications associated with direct jejunal feeding. We hypothesized that jejunal feeding may cause life-threatening surgical complications in a minority of patients.
Methods
All patients undergoing jejunal feeding between 1/2008 and 1/2018 at a pediatric surgical unit were identified retrospectively. Data sought from records included demographics, comorbidities, indications, feeding strategies, adverse events, and follow-up. Major surgical complications were defined by Clavien–Dindo grade ≥ IIIb and involving the GI tract (excluding changes of jejunal tube).
Main results
197 patients were identified (110 female). Median age (IQR) at initiation of jejunal feeding months was 5.6 (6–164) months. 122 were neurologically impaired. The most frequent indications were: GERD/gastroparesis (n = 114), prophylaxis/treatment of Superior Mesenteric Artery (SMA) syndrome (N.B. our center is a national spinal deformity unit) (n = 47), congenital anomalies of aerodigestive anatomy (n = 17), and malignancy (n = 7). 125 patients were managed with nasojejunal feeding alone: gastrojejunal tube (n = 51) and via Roux-en-Y jejunostomy (n = 21). There were 14 significant gastrointestinal complications (n = 11 grade > IIIb) identified among 12 patients, of whom 8 required bowel resections, and 2 died as a result: nonmechanical bowel ischemia (n = 7), intussusception (n = 4), and volvulus (n = 3).
Conclusion
This series highlights the major complications of jejunal feeding, including a significant yet underreported risk of gut compromise. Patients undergoing jejunal feeding had a 6.1% risk of developing major surgical complications (of note, 3.6% developed bowel ischemia of unknown etiology). Susceptible children were comorbid, fragile, and neurologically impaired. These findings should influence parental discussions and informed consent before embarking upon jejunal feeding.
Level of evidence
Level IV prognosis study.