Obesity and Overweight Among Children With Medical Complexity.

OBJECTIVES: To assess the prevalence of overweight or obesity among children with medical complexity (CMC), compared with children without medical complexity, and explore potentially modifiable mechanisms. METHODS: This study involved a retrospective cohort of 41 905 children ages 2 to 18 seen in 2019 at a single academic medical center. The primary outcome was overweight or obesity, defined as a body mass index of ≥85% for age and sex. CMC was defined as ≥1 serious chronic condition in ≥1 system. Obesogenic conditions and medications were defined as those typically associated with excess weight gain. Multivariable logistic regression was used to adjust for common confounders. RESULTS: Of the children in the cohort, 29.5% were CMC. Overweight or obesity prevalence was higher among CMC than non-CMC (31.9% vs 18.4%, P ≤.001, adjusted odds ratio [aOR] 1.27, 95% confidence interval [CI] 1.20-1.35). Among CMC, the risk for overweight or obesity was higher among children with metabolic conditions (aOR 2.09, 95% CI 1.88-2.32), gastrointestinal conditions (aOR 1.23 95% CI 1.06-1.41), malignancies (aOR 1.21 95% CI 1.07-1.38), and Spanish-speaking parents (aOR 1.47 95% CI 1.30-1.67). Among overweight or obese CMC, 91.6% had no obesogenic conditions, and only 8.5% had been seen by a registered dietitian in the previous year. CONCLUSIONS: CMC are significantly more likely to be overweight or obese when compared with children without medical complexity. Although many CMC cases of overweight appear to be preventable, further research is necessary to determine if and how to prevent comorbid obesity among CMC.

Preoperative Evaluation Is Not Predictive of Transpyloric Feeding Conversion in Gastrostomy-dependent Pediatric Patients.

OBJECTIVES: Limited literature exists as to whether preoperative gastrostomy (GT) evaluation may predict which patients will go onto require gastrojejunostomy (GJ) tube feeding. The goal of this study was to compare the preoperative evaluations between patients maintained on GT feeds versus patients who required conversion to GJ feeds. METHODS: We identified patients at Boston Children's Hospital who underwent GT tube placement and required GJ feeding between 2006 and 2012. GT patients were matched according to age, neurologic, and cardiac status with GJ-converted patients. Preoperative characteristics, rates of total hospitalizations, and respiratory-related admissions were reviewed. RESULTS: A total of 79 GJ patients (median interquartile range (IQR): age 15 (4.3, 55.7) months; weight 8.8 (4.6, 14.5) kg) were matched with 79 GT patients (median (IQR): age 14.6 (4.7, 55.7) months; weight 8.5 (5, 13.6) kg). Median time from GT to GJ conversion was 8 (IQR 3, 16) months. Both groups had similar rates of successful preoperative nasogastric feeding trials (GT (84.5%) versus GJ (83.1%), P = 1.0), upper gastrointestinal series (GT (89.1%) versus GJ (93.2%), P = 0.73), abnormal videofluoroscopic swallow studies (GT (53.8%) versus GJ (62.2%), P = 0.4), and completion of gastric emptying studies (GT (10.1%) versus GJ (5.1%), P = 0.22). No differences were seen in preoperative hospitalization rates (P = 0.25), respiratory admissions (P = 0.36), although GJ patients had a mean reduction in the number of hospitalization of -1.5 ±â€Š0.5 days, P < 0.001, after conversion. CONCLUSIONS: No differences in preoperative patient characteristics or diagnostic evaluations were seen in GT fed versus GJ converted patients. GJ patients did experience an overall decrease in total admissions after GJ conversion.