Background:

Gastrostomy tube (G-tube) placement for children with neurologic impairment with dysphagia has been suggested for pneumonia prevention. However, prior studies demonstrated an association between G-tube placement and increased risk of pneumonia. We evaluate the association between timing of G-tube placement and death or severe pneumonia in children with neurologic impairment.

Methods:

We included all children enrolled in California Children’s Services between July 1, 2009, and June 30, 2014, with neurologic impairment and 1 pneumonia hospitalization. Prior to analysis, children with new G-tubes and those without were 1:2 propensity score matched on sociodemographics, medical complexity, and severity of index hospitalization. We used a time-varying Cox proportional hazard model for subsequent death or composite outcome of death or severe pneumonia to compare those with new G-tubes vs those without, adjusting for covariates described above.

Results:

A total of 2490 children met eligibility criteria, of whom 219 (9%) died and 789 (32%) had severe pneumonia. Compared to children without G-tubes, children with new G-tubes had decreased risk of death (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.39-0.55) but increased risk of the composite outcome (HR 1.21, CI 1.14-1.27). Sensitivity analyses using varied time criteria for definitions of G-tube and outcome found that more recent G-tube placement had greater associated risk reduction for death but increased risk of severe pneumonia.

Conclusion:

Recent G-tube placement is associated with reduced risk of death but increased risk of severe pneumonia. Decisions to place G-tubes for pulmonary indications in children with neurologic impairment should weigh the impact of severe pneumonia on quality of life.

中文翻译：

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放置在患有神经功能障碍的儿童中的胃造口管：相关的发病率和死亡率

背景：

已建议为患有吞咽困难的神经障碍儿童放置胃造口管（G 管）以预防肺炎。然而，先前的研究表明 G 管放置与肺炎风险增加之间存在关联。我们评估了 G 管放置时间与神经功能障碍儿童死亡或严重肺炎之间的关联。

方法：

我们纳入了 2009 年 7 月 1 日至 2014 年 6 月 30 日期间在加州儿童服务中心注册的所有患有神经功能障碍和 1 例肺炎住院的儿童。在分析之前，有新 G 管的儿童和没有新 G 管的儿童在社会人口统计学、医疗复杂性和指数住院严重程度方面的倾向得分为 1:2。我们对随后的死亡或死亡或严重肺炎的复合结果使用时变 Cox 比例风险模型来比较那些使用新 G 管与那些没有，调整上述协变量。

结果：

共有 2490 名儿童符合入选标准，其中 219 人（9%）死亡，789 人（32%）患有重症肺炎。与未使用 G 管的儿童相比，使用新 G 管的儿童死亡风险降低（风险比 [HR] 0.47，95% 置信区间 [CI] 0.39-0.55），但复合结局的风险增加（HR 1.21，CI 1.14-1.27)。使用不同时间标准来定义 G 管和结果的敏感性分析发现，最近的 G 管放置具有更大的相关死亡风险降低，但增加了重症肺炎的风险。

结论：

最近的 G 管放置与死亡风险降低但重症肺炎风险增加有关。将 G 管用于神经功能障碍儿童的肺部适应症的决定应权衡重症肺炎对生活质量的影响。