Gastrostomy a More Nutritious Option for Children with Tetraparesis Cerebral Palsy, Study Finds

Pediatric patients with tetraparesis cerebral palsy (TCP) who are fed by gastrostomy, which is the insertion of a feeding tube into the stomach via an external opening in the abdomen, receive better nutrition than patients fed orally, a new study found.

The study, “Comparative study on gastrostomy and orally nutrition of children and adolescents with tetraparesis cerebral palsy,” was published in the journal Arquivos de Gastroenterologia.

TCP is characterized by paralysis of the four limbs. It can also cause seizures and respiratory complications and is often associated with dysfunctional feeding due to uncoordinated swallowing and breathing. As a result, patients do not receive adequate nutrients and can become malnourished. This can lead to related problems including infections and even death.

Gastrostomy tube feeding (GTF) is indicated for children with feeding difficulties, but until now, no studies had shown definitive evidence to support the procedure’s benefits. Theoretically, those benefits include providing nutrition effectively and safely while reversing malnutrition and improving general health.

To verify the benefits of GTF, a Brazilian research team compared the nutritional status and diets of pediatric TCP patients using GTF with those being orally fed.

The teams studied 54 children and adolescents with TCP whose ages ranged from 2-18. Twenty-five patients were fed by GTF, and 29 received food orally. The GTF group was fed an industrialized, artisanal, or mixed (industrialized + artisanal) diet.

Researchers looked at weight, knee height, estimated height, skin folds, and body circumferences.

Results showed that the orally fed TCP patients had reduced fat and muscle tissue. Additionally, although the orally fed group had a higher intake of protein and fiber, they were more malnourished than the GTF group.

Comparison between diets used by the GTF group revealed that the mixed diet (industrialized + artisanal) supplied more protein and fiber (17.11% and 10.65%, respectively) than the industrialized diet (12.55% and 4.04%, respectively), which in turn provided an increased intake of lipids. According to the team, feeding formulas should be enriched with fibers because most cerebral palsy patients experience constipation, and low dietary fiber intake might be a cause.

“Comparing the groups, the tetraparesis cerebral palsy patients fed orally have a greater impairment of their nutritional status, even though they have higher intakes of protein and fiber than those patients fed by gastrostomy, demonstrating a consistent argument for the use of gastrostomy,” the researchers concluded.

“We strongly suggest an adequate supply of fiber for the care and prevention of constipation,” the team added.