When are jejunum (small intestine) feeding tubes recommended for pediatric cerebral palsy cases?

From the Guidelines

Jejunum feeding tubes are recommended for pediatric cerebral palsy cases when there are specific contraindications to gastric feeding or when gastric feeding has failed, as they can reduce mechanical complications and aspiration risk, as suggested by the ESPEN guideline on home enteral nutrition 1. When considering jejunum feeding tubes for pediatric cerebral palsy cases, it is essential to evaluate the patient's individual needs and medical history. According to the ESPEN guideline, percutaneous tubes should be used instead of nasal tubes for long-term needs (at least 4-6 weeks) to reduce mechanical complications such as blocking and dislodgement 1.

Key Considerations

• Severe gastroesophageal reflux disease (GERD) that is unresponsive to medical management or surgical intervention
• Recurrent aspiration pneumonia despite fundoplication
• Gastroparesis with delayed gastric emptying
• Gastric outlet obstruction
• Previous gastric surgery that prevents placement of a gastrostomy tube
• Persistent vomiting, retching, or feeding intolerance with gastrostomy tubes The decision to place a jejunal tube should be made after a comprehensive evaluation by a multidisciplinary team, including a pediatric gastroenterologist, nutritionist, and neurologist.

Feeding Regimen

• Continuous infusion rather than bolus feeds due to the limited capacity of the jejunum
• Starting at a slow rate (e.g., 1-2 ml/kg/hour) and gradually increasing as tolerated
• Complete nutrition formulas designed for jejunal feeding should be used
• Careful monitoring for complications such as tube dislodgement, clogging, or small bowel obstruction is essential, as mechanical complications are quite frequent in patients on home enteral nutrition (HEN) 1.

Tube Care and Complications

• Meticulous tube care is necessary to prevent infection risk
• Routine water flushing after feedings can prevent tube occlusion, especially in small-caliber tubes like jejunostomies 1
• If the tube does become clogged, simple water flushing can help regain patency, but other methods such as infusion with cola-containing carbonated drinks or pancreatic enzymes are not recommended due to the risk of tube contamination with bacteria 1

From the Research

Jejunum Feeding Tubes for Cerebral Palsy Pediatric Cases

• Jejunum feeding tubes are recommended for pediatric cerebral palsy cases when children have significant disabilities in terms of sucking, chewing, and swallowing, leading to impairment in feeding and potential undernutrition 2, 3.
• The decision to use a jejunostomy feeding tube is often considered when a child is unable to maintain a normal nutritional state through oral feeding alone, and gastrostomy or jejunostomy tubes are used to provide nutrients directly into the digestive system 2, 3.
• Children with generalized severe motor impairment, such as spastic quadriplegia, are more likely to experience greater swallowing deficits and may benefit from jejunum feeding tubes 4.
• The management of cerebral palsy involves a multidisciplinary approach, including neurological rehabilitation, diagnosis, and management of co-morbidities, such as gastrointestinal function disturbances, which may require the use of jejunum feeding tubes 5.
• Studies have shown that the use of jejunum feeding tubes can improve the quality of life for children with severe cerebral palsy and their families, despite potential minor complications 6.
• The effectiveness and safety of jejunostomy feeding tubes for children with cerebral palsy require further assessment, and well-designed randomized controlled trials are needed to resolve current uncertainties 2, 3.