Gastrostomy tube supplementation for HIV-infected children

Objectives. 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 compositi...

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Published in:	Pediatrics (Evanston) Vol. 96; no. 4; pp. 696 - 702
Main Authors:	Miller, T.L. (Children's Hospital/Hunnewell Ground, Boston, MA.), Awnetwant, E.L, Evans, S, Morris, V.M, Vazquez, I.M, McIntosh, K
Format:	Journal Article
Language:	English
Published:	Elk Grove Village, IL American Academy of Pediatrics 01-10-1995
Subjects:	Acquired Immunodeficiency Syndrome - therapy AGE AIDS/HIV ALIMENTACION ALIMENTATION ALTURA APPAREIL DIGESTIF BEBES Biological and medical sciences Child Child, Preschool Children & youth CONTEO DE CELULAS EDAD ENERGIA ENERGIE Energy Intake ENFANT ENFANT EN BAS AGE Enteral feeding Enteral nutrition Enteral Nutrition - adverse effects Evaluation GAIN DE POIDS GANANCIA DE PESO GENERO HUMANO GENRE HUMAIN HAUTEUR Health aspects HERPETOVIRIDAE HIV HIV infection in children HIV Infections - physiopathology HIV Infections - therapy Human immunodeficiency virus Humans Immunodeficiencies Immunodeficiencies. Immunoglobulinopathies Immunopathology Infant INGESTION DE NUTRIENTES INGESTION DE SUBSTANCES NUTRITIVES LEUCOCITOS LEUCOCYTE LINFOCITOS LYMPHOCYTE MASSACHUSETTS Medical equipment Medical sciences MEDICION DEL CUERPO MENSURATION CORPORELLE MORBIDITE Morbidity MORBOSIDAD MORTALIDAD MORTALITE NINOS NUMERATION CELLULAIRE NUTRICION HUMANA Nutrition NUTRITION HUMAINE PATHOGENESE PATOGENESIS Pediatric HIV infections Pediatrics PESO POIDS SERVICE DE SANTE PUBLIQUE SERVICIOS DE SALUD SINTOMAS SISTEMA DIGESTIVO SYMPTOME TECHNIQUE DE PREVISION TECNICAS DE PREDICCION TEJIDO ADIPOSO TISSU ADIPEUX Tube feeding Weight Gain Human Gastrostomy Immunopathology Prognosis Treatment efficiency Body weight Retroviridae AIDS Immune deficiency Body composition Enteral administration Feeding Infection Virus Treatment Viral disease T-Lymphocyte Nasogastric Lentivirinae Complication Human immunodeficiency virus Malnutrition Child Nutritional status
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Summary:	Objectives. 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 0.65, P = 0.002) and a decrease in hospital days after the gastrostomy tube was placed (r = -.48, P = 0.025). 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 = 0.85, P = 0.0001). 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 = 0.005). Conclusion. Gastrostomy tube supplementation for HIV-infected children can improve weight
Bibliography:	S30 T10 9625988 ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23
ISSN:	0031-4005 1098-4275
DOI:	10.1542/peds.96.4.696