       Document 0218
 DOCN  M9610218
 TI    Gastrostomy tube supplementation for HIV-infected children.
 DT    9601
 AU    Miller TL; Awnetwant EL; Evans S; Morris VM; Vazquez IM; McIntosh K;
       Combined Program in Pediatric Gastroenterology and Nutrition,;
       Children's Hospital, Boston, MA 02115, USA.
 SO    Pediatrics. 1995 Oct;96(4 Pt 1):696-702. Unique Identifier : AIDSLINE
       MED/96000161
 AB    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.
 DE    Acquired Immunodeficiency Syndrome/THERAPY  Caloric Intake  Child
       Child, Preschool  *Enteral Nutrition/ADVERSE EFFECTS  Human  HIV
       Infections/PHYSIOPATHOLOGY/*THERAPY  Infant  Support, Non-U.S. Gov't
       Support, U.S. Gov't, P.H.S.  Weight Gain  JOURNAL ARTICLE

       SOURCE: National Library of Medicine.  NOTICE: This material may be
       protected by Copyright Law (Title 17, U.S.Code).

