Derek Leung, Louise Thomson, Kath Sharp, Gregor Walker, Philip Davies
Royal Hospital for Sick Children, Yorkhill, Glasgow, UK
Children with quadriplegic cerebral palsy (CP) are prone to recurrent aspiration and assessment of the safety of their swallow and gastro-oesophageal reflux (GOR) is a key part of their management. In these patients, placement of a gastrostomy reduces the risk of aspiration during swallowing and supplements nutritional intake. A fundoplication is often carried out at the time of gastrostomy insertion if moderate GOR is identified pre-operatively.
To establish how children with CP in Glasgow are assessed for their risk of aspiration and GOR and to assess the clinical outcomes of CP patients following gastrostomy insertion.
All patients with quadriplegic CP attending specialist school in Greater Glasgow in 2012 were identified as part of a respiratory team initiative from the Royal Hospital for Sick Children (Yorkhill). Medical and speech and language therapy (SALT) case notes and computer database records were retrospectively analysed for investigations, medical therapy, therapeutic procedures, and hospitalisation for respiratory-related events.
Forty-nine children were identified. Of those, 39 (80%) had active or previous SALT records and 10 (20%) had previous video fluoroscopy performed. Twenty-five children had a gastrostomy inserted, and 11 (44%) underwent fundoplication at some stage. Twenty-one (84%) children were assessed pre-gastrostomy for GOR (10-pH study, 12-barium study, 1-upper GI endoscopy) and 12 (40%) had some evidence of GOR preoperatively. Four children were offered fundoplication at the time of gastrostomy, 4 underwent subsequent fundoplication and a further 4 received long term medical anti-reflux treatment. Two out of nine (22%) with no evidence of GOR preoperatively, and 1 child who had no pre-gastrostomy investigations required fundoplication at a later date for GOR. Of the 24 CP patients who have not had a percutaneous endoscopic gastrostomy (PEG), 21 have had SALT input and none have had a video fluoroscopy. Two have had a barium study and 1 has had a pH study.
Most, but not all, children with quadriplegic CP have records of SALT involvement prior to PEG insertion. GOR is common in children with quadriplegic CP but the significance of mild GOR on pre-operative investigations is unclear. A significant number of children with quadriplegic CP that do not undergo a fundoplication at the time of gastrostomy insertion require surgical or medical treatment of GOR at a later date.
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