Journal
JOURNAL OF PARENTERAL AND ENTERAL NUTRITION
Volume 46, Issue 1, Pages 215-221Publisher
WILEY
DOI: 10.1002/jpen.2100
Keywords
enteral nutrition; pediatrics; tube weaning
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This study examined the tube-weaning practice of a group of pediatric gastroenterologists managing children receiving prolonged enteral nutrition. The results showed significant practice variation, with most respondents using individualized weaning programs and preferring home-based weaning attempts. The study highlights the need for standardized tube-weaning programs based on increased knowledge about different weaning modalities.
Background No consensus currently exists on tube-weaning practice worldwide. The aim of this study was to describe tube-weaning practice (indications and modalities) of a panel of pediatric gastroenterologists involved in the management of prolonged enteral nutrition (EN). Methods A cross-sectional survey of pediatric gastroenterologists involved in the management of children receiving prolonged (>3 months) EN who were likely to be weaned was conducted. A questionnaire containing 24 questions was disseminated to the French Speaking Group of Paediatric Gastroenterology, Hepatology, and Nutrition members. The association between weaning practice and the experience of respondents was investigated. Results In total, 311 professionals were approached, and 64 questionnaires were completed (response rate 21%). Nearly all respondents (n = 61, 95%) reported using individualized weaning programs. Weaning attempts were performed more frequently at home, and follow-up was performed in the outpatient clinic (97%) by progressive EN volume reduction (83%). Inpatient weaning was performed by only 28% of participants. The choice of the setting was predominantly (59%) based on parental request. Management and follow-up involved mainly the referring pediatric gastroenterologist and the dietitian. Fifty-one (80%) of the respondents experienced >= 1 weaning failure. Conclusions This is one of only a few studies examining real-life pediatric tube-weaning practices. Considerable practice variation between centers was observed; some of the common practices included the setting of weaning (outpatient vs inpatient) and the eligibility criteria. Increasing knowledge about weaning modalities is the starting point for the design of consensual standardized programs.
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