Claudio Romano1, Valeria Dipasquale1, Myriam Van Winckel2, Jessie Hulst3, Ilse Broekaert4, Jiri Bronsky5, Luigi Dall'Oglio6, Nataša Fidler Mis7, Iva Hojsak8, Rok Orel9, Alexandra Papadopoulou10, Michela Schaeppi11, Nikhil Thapar12, Michael Wilschanski13, Peter Sullivan14, Frédéric Gottrand15. 1. Unit of Pediatric Gastroenterology and Cystic Fibrosis Unit, Department of Human Pathology in Adulthood and Childhood "G. Barresi", University of Messina, Messina, Italy. 2. Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, Ghent University Hospital, Ghent, Belgium. 3. Division of Gastroenterology, Hepatology and Nutrition, Department of Pediatrics, The Hospital for Sick Children, Toronto, Canada. 4. Department of Paediatrics, Faculty of Medicine and University Hospital Cologne, University of Cologne, Cologne, Germany. 5. Department of Paediatrics, University Hospital Motol, Prague, Czech Republic. 6. Bambino Gesù Children's Hospital, Research Institute, Digestive Endoscopy and Surgery, Rome, Italy. 7. Department of Gastroenterology, Hepatology and Nutrition, University Children's Hospital, University Medical Centre Ljubljana, Ljubljana, Slovenia. 8. Children's Hospital Zagreb, Zagreb, University of Zagreb School of medicine, Zagreb, University J.J. Strossmayer School of medicine, Osijek, Croatia. 9. Department of Gastroenterology, Hepatology and Nutririon, University Children's Hospital Ljubljana, Medical Faculty, University of Ljubljana, Ljubljana, Slovenia. 10. Division of Gastroenterology and Hepatology, First Department of Pediatrics, University of Athens, Children's hospital Agia Sofia, Athens, Greece. 11. Pediatric Center, Clinique des Grangettes, Geneva, Switzerland. 12. Department of Pediatric Gastroenterology, Great Ormond Street Hospital NHS Foundation Trust, London, United Kingdom. 13. Pediatric Gastroenterology Unit, Division of Pediatrics, Hadassah Hebrew University Medical Center, Jerusalem, Israel. 14. University of Oxford, Department of Paediatrics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK. 15. University Lille, CHU Lille, Inserm U1286 Infinite, Department of pediatric gastroenterology hepatology and nutrition, Lille, France.
Abstract
OBJECTIVES: The main aim of this study was to determine the impact on clinical practice of the first European Society of Gastroenterology, Hepatology, and Nutrition (ESPGHAN) position paper on the diagnosis and management of nutritional and gastrointestinal problems in children with neurological impairment (NI). METHODS: In this pilot-study, a web-based questionnaire was distributed between November, 2019 and June, 2020, amongst ESPGHAN members using the ESPGHAN newsletter. Fifteen questions covered the most relevant aspects on nutritional management and gastrointestinal issues of children with NI. A descriptive analysis of responses was performed. RESULTS: A total of 150 health professionals from 23 countries responded to the survey. A considerable variation in clinical practice concerning many aspects of nutritional and gastrointestinal management of children with NI was observed. The most frequently used method for diagnosing oropharyngeal dysfunction was the direct observation of meals with or without the use of standardised scores (n = 103). Anthropometric measurements were the most commonly used tools for assessing nutritional status (n = 111). The best treatment for gastroesophageal reflux disease (GERD) was considered to be proton pump inhibitor therapy by most (n = 116) participants. Regarding tube feeding, nearly all respondents (n = 114) agreed that gastrostomy is the best enteral access to be used for long-term enteral feeding. Fundoplication was indicated at the time of gastrostomy placement especially in case of uncontrolled GERD. CONCLUSIONS: More studies are required to address open questions on adequate management of children with NI. Identifying knowledge gaps paves the way for developing updated recommendations and improving patient care.
OBJECTIVES: The main aim of this study was to determine the impact on clinical practice of the first European Society of Gastroenterology, Hepatology, and Nutrition (ESPGHAN) position paper on the diagnosis and management of nutritional and gastrointestinal problems in children with neurological impairment (NI). METHODS: In this pilot-study, a web-based questionnaire was distributed between November, 2019 and June, 2020, amongst ESPGHAN members using the ESPGHAN newsletter. Fifteen questions covered the most relevant aspects on nutritional management and gastrointestinal issues of children with NI. A descriptive analysis of responses was performed. RESULTS: A total of 150 health professionals from 23 countries responded to the survey. A considerable variation in clinical practice concerning many aspects of nutritional and gastrointestinal management of children with NI was observed. The most frequently used method for diagnosing oropharyngeal dysfunction was the direct observation of meals with or without the use of standardised scores (n = 103). Anthropometric measurements were the most commonly used tools for assessing nutritional status (n = 111). The best treatment for gastroesophageal reflux disease (GERD) was considered to be proton pump inhibitor therapy by most (n = 116) participants. Regarding tube feeding, nearly all respondents (n = 114) agreed that gastrostomy is the best enteral access to be used for long-term enteral feeding. Fundoplication was indicated at the time of gastrostomy placement especially in case of uncontrolled GERD. CONCLUSIONS: More studies are required to address open questions on adequate management of children with NI. Identifying knowledge gaps paves the way for developing updated recommendations and improving patient care.