Page 101 - Effects and Efficacy of (Laparoscopic) Gastrostomy Placement in Children - Josephine Franken

inTRoDUCTion
A gastrostomy placement (GP) is an effective treatment to provide enteral tube feeding in children in need of nutritional support. 1,2 Previous studies on GP in children have focused primarily on the physical outcomes of patients after operation. 3 Health-related quality of life (HRQoL) is increasingly recognized as an essential component of patient care outcomes. It aims to assess the impact of an illness and its treatment on the dimensions of physical, psychological and social health. 4-8 However, little is known about HRQoL as a patient care outcome in children undergoing GP, and about the factors influencing HRQoL.
The main indication for GP in children is feeding difficulty, in most cases caused by neurologic impairment (NI), cardiac disease or cystic fibrosis. 9 In the majority of these children, HRQoL may be profoundly affected by the child’s primary health condition, and can be expected to differ among various morbidities. However, other factors, such as complications related to GP (e.g. infections at the gastrostomy site, for which admission at the hospital may be indicated) or gastroesophageal reflux, may also influence the HRQoL. 2,10
Few studies performed in children undergoing GP have focused on HRQoL. One study investigated quality of life in children before and after GP, reporting no significant changes. 11 However, this study did not use validated questionnaires for quality of life assessment. A few other studies focused on the experience of parents of children undergoing GP. 12-14 These studies reported a positive impact of GP on the HRQoL of parents, seen in a decrease in burden of care13 and an increase in self-reported social functioning, energy and general health perception. 12 These studies did not report on the HRQoL of the children themselves. To our knowledge, there is a lack of well-designed studies on the HRQoL in children undergoing GP. Where the aforementioned studies did not use validated HRQoL questionnaires, in this study the Pediatric Quality of Life (PedsQLTM) 4.0 Generic Core Scales was used. This is a reliable and valid tool for proxy-report of HRQoL by caregivers and a parallel self-report for children. It has been used to assess HRQoL in healthy populations, as well as in children with numerous acute and chronic health conditions. 5-7
Although most children have little alternative for GP, it is important to understand the population undergoing GP and the consequences of GP itself on the lives of these children. This knowledge can help physicians provide better counselling to caregivers before and after GP. The aim of our study was to evaluate HRQoL in children with severe feeding difficulty who have been treated with GP and to identify predictors (both patient characteristics and gastrostomy-related factors) of HRQoL.
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