Gastrostomy tube supplementation for HIV-infected children

Tracie L Miller, E. L. Awnetwant, S. Evans, V. M. Morris, I. M. Vazquez, K. McIntosh

Research output: Contribution to journalArticle

50 Citations (Scopus)

Abstract

Objective. Malnutrition is common in pediatric human immunodeficiency virus (HIV) infection, and little is known of effective nutritional interventions. We sought to determine whether enteral supplementation with gastrostomy tube feedings would provide improvements in weight, height, body composition, immune parameters, morbidity, and mortality. Methods. We collected clinical data on 23 HIV-infected children who were fed chronically by gastrostomy tube. The main outcome measures included weight, height, triceps skinfold thickness (TSF), arm-muscle circumference (AMC), hospital days, caloric intake, and CD4-positive T-lymphocyte count. Each of these parameters was measured or evaluated at four points: 6 months before nasogastric tube feeding, at the time nasogastric tube feeding was initiated, at the time gastrostomy tube feeding was initiated, and 6 months after gastrostomy tube feedings began. Results. Weight z score [-2.1 (0.14) to - 1.58 (0.14)] and weight-for-height z score [-0.98 (0.16) to -0.15 (0.17)] improved with gastrostomy tube feedings. There was a trend toward improvement in weight z score with nasogastric tube feedings. Caloric intakes increased progressively with nasogastric and gastrostomy tube feedings. No improvement in height, TSF, AMC, hospital days, or CD4 counts was seen in the follow-up period. However, children who had the greatest increase in weight had the most improvement in fat stores (TSF) (r = .65, P = .002) and a decrease in hospital days after the gastrostomy tube was placed (r = -.48, P = .025). Higher age-adjusted CD4 counts and lower weight-for-height z scores at the time of enteral supplementation were significant predictors of a positive response to gastrostomy tube feedings (r = .85, P = .0001). Children who responded favorably had a 2.8-fold reduction in the risk of dying for every positive unit change in weight z score (P = .005). Conclusion. Gastrostomy tube supplementation for HIV-infected children can improve weight and fat mass when other oral methods fail. Weight gain is coincident with greater caloric intakes. HIV-infected children with higher CD4 counts and lower weight-for-height z scores are likely to respond favorably to gastrostomy tube feedings. Early nutritional intervention is indicated for HIV-infected children.

Original languageEnglish
Pages (from-to)696-702
Number of pages7
JournalPediatrics
Volume96
Issue number4 I
StatePublished - Jan 1 1995
Externally publishedYes

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Gastrostomy
Enteral Nutrition
HIV
Weights and Measures
Skinfold Thickness
CD4 Lymphocyte Count
Energy Intake
Small Intestine
Fats
CD4-Positive T-Lymphocytes
Muscles
Lymphocyte Count
Virus Diseases
Risk Reduction Behavior
Body Composition
Malnutrition
Weight Gain
Outcome Assessment (Health Care)
Pediatrics
Morbidity

Keywords

  • children
  • gastrostomy tube
  • human immunodeficiency virus
  • morbidity
  • nutrition

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

Miller, T. L., Awnetwant, E. L., Evans, S., Morris, V. M., Vazquez, I. M., & McIntosh, K. (1995). Gastrostomy tube supplementation for HIV-infected children. Pediatrics, 96(4 I), 696-702.

Gastrostomy tube supplementation for HIV-infected children. / Miller, Tracie L; Awnetwant, E. L.; Evans, S.; Morris, V. M.; Vazquez, I. M.; McIntosh, K.

In: Pediatrics, Vol. 96, No. 4 I, 01.01.1995, p. 696-702.

Research output: Contribution to journalArticle

Miller, TL, Awnetwant, EL, Evans, S, Morris, VM, Vazquez, IM & McIntosh, K 1995, 'Gastrostomy tube supplementation for HIV-infected children', Pediatrics, vol. 96, no. 4 I, pp. 696-702.
Miller TL, Awnetwant EL, Evans S, Morris VM, Vazquez IM, McIntosh K. Gastrostomy tube supplementation for HIV-infected children. Pediatrics. 1995 Jan 1;96(4 I):696-702.
Miller, Tracie L ; Awnetwant, E. L. ; Evans, S. ; Morris, V. M. ; Vazquez, I. M. ; McIntosh, K. / Gastrostomy tube supplementation for HIV-infected children. In: Pediatrics. 1995 ; Vol. 96, No. 4 I. pp. 696-702.
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abstract = "Objective. Malnutrition is common in pediatric human immunodeficiency virus (HIV) infection, and little is known of effective nutritional interventions. We sought to determine whether enteral supplementation with gastrostomy tube feedings would provide improvements in weight, height, body composition, immune parameters, morbidity, and mortality. Methods. We collected clinical data on 23 HIV-infected children who were fed chronically by gastrostomy tube. The main outcome measures included weight, height, triceps skinfold thickness (TSF), arm-muscle circumference (AMC), hospital days, caloric intake, and CD4-positive T-lymphocyte count. Each of these parameters was measured or evaluated at four points: 6 months before nasogastric tube feeding, at the time nasogastric tube feeding was initiated, at the time gastrostomy tube feeding was initiated, and 6 months after gastrostomy tube feedings began. Results. Weight z score [-2.1 (0.14) to - 1.58 (0.14)] and weight-for-height z score [-0.98 (0.16) to -0.15 (0.17)] improved with gastrostomy tube feedings. There was a trend toward improvement in weight z score with nasogastric tube feedings. Caloric intakes increased progressively with nasogastric and gastrostomy tube feedings. No improvement in height, TSF, AMC, hospital days, or CD4 counts was seen in the follow-up period. However, children who had the greatest increase in weight had the most improvement in fat stores (TSF) (r = .65, P = .002) and a decrease in hospital days after the gastrostomy tube was placed (r = -.48, P = .025). Higher age-adjusted CD4 counts and lower weight-for-height z scores at the time of enteral supplementation were significant predictors of a positive response to gastrostomy tube feedings (r = .85, P = .0001). Children who responded favorably had a 2.8-fold reduction in the risk of dying for every positive unit change in weight z score (P = .005). Conclusion. Gastrostomy tube supplementation for HIV-infected children can improve weight and fat mass when other oral methods fail. Weight gain is coincident with greater caloric intakes. HIV-infected children with higher CD4 counts and lower weight-for-height z scores are likely to respond favorably to gastrostomy tube feedings. Early nutritional intervention is indicated for HIV-infected children.",
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N2 - Objective. Malnutrition is common in pediatric human immunodeficiency virus (HIV) infection, and little is known of effective nutritional interventions. We sought to determine whether enteral supplementation with gastrostomy tube feedings would provide improvements in weight, height, body composition, immune parameters, morbidity, and mortality. Methods. We collected clinical data on 23 HIV-infected children who were fed chronically by gastrostomy tube. The main outcome measures included weight, height, triceps skinfold thickness (TSF), arm-muscle circumference (AMC), hospital days, caloric intake, and CD4-positive T-lymphocyte count. Each of these parameters was measured or evaluated at four points: 6 months before nasogastric tube feeding, at the time nasogastric tube feeding was initiated, at the time gastrostomy tube feeding was initiated, and 6 months after gastrostomy tube feedings began. Results. Weight z score [-2.1 (0.14) to - 1.58 (0.14)] and weight-for-height z score [-0.98 (0.16) to -0.15 (0.17)] improved with gastrostomy tube feedings. There was a trend toward improvement in weight z score with nasogastric tube feedings. Caloric intakes increased progressively with nasogastric and gastrostomy tube feedings. No improvement in height, TSF, AMC, hospital days, or CD4 counts was seen in the follow-up period. However, children who had the greatest increase in weight had the most improvement in fat stores (TSF) (r = .65, P = .002) and a decrease in hospital days after the gastrostomy tube was placed (r = -.48, P = .025). Higher age-adjusted CD4 counts and lower weight-for-height z scores at the time of enteral supplementation were significant predictors of a positive response to gastrostomy tube feedings (r = .85, P = .0001). Children who responded favorably had a 2.8-fold reduction in the risk of dying for every positive unit change in weight z score (P = .005). Conclusion. Gastrostomy tube supplementation for HIV-infected children can improve weight and fat mass when other oral methods fail. Weight gain is coincident with greater caloric intakes. HIV-infected children with higher CD4 counts and lower weight-for-height z scores are likely to respond favorably to gastrostomy tube feedings. Early nutritional intervention is indicated for HIV-infected children.

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