Earlier G-Tube Placement Linked to Better Outcomes in Children with Cystic Fibrosis

For children with cystic fibrosis, nutrition is a critical component of treatment. Challenges with nausea, constipation, and malabsorption mean that a g-tube is sometimes needed to optimize intake. But when is it the right time to make that decision?

Most caregivers want to evaluate g-tube placement strictly as a last resort, when all other options have been tried. This sometimes leads to waiting until a child is older or malnourished before attempting placement. But a retrospective look at outcomes based on age and timing may help CF specialists with data on optimal placement.

Brittany Wall, MD, pediatric pulmonologist at UVA Health Children’s, led a research team to examine the timing of G-tube placement as it related to outcomes in CF patients. The retrospective analysis looked at 10 years of registry data from the U.S. Cystic Fibrosis Foundation Patient Registry, examining children born from 2003 through 2019. Researchers found that age and nutritional status at the time of G-tube placement were associated with differences in nutritional recovery and lung function, and that earlier placement was often better.

These findings may help CF specialists evaluate when to consider supplemental enteral nutrition, particularly before malnutrition becomes severe.

Cystic Fibrosis & the Challenge of Nutrition

Cystic fibrosis’ effects on lung function are the most urgent. But CF affects multiple organ systems, including digestion. Pancreatic blockages, constipation, and nutrient malabsorption can lead to malnutrition. Newborns with CF are often diagnosed with “failure to thrive.” Before newborn screenings for CF existed, failure to thrive was often the first sign of CF in small children.

Today, clinicians better understand the connection between good nutrition and pulmonary health. Proper nutrition leads to a healthier weight, which leads to better lung growth. “Good growth equals good lung health, which means better lung function in the long run,” says Wall.

For children with CF, meeting increased energy needs can be challenging. Nausea, vomiting, constipation, and other factors can make it difficult to consume enough calories to support growth.

A G-tube can provide supplemental feedings and help ensure that children receive enough calories. In some cases, overnight tube feedings provide nutrition while a child sleeps, helping close the gap between what the child can comfortably eat and their nutritional needs.

The decision to place a G-tube can be difficult. “It’s always a hard conversation to have with families,” says Wall. Caregivers often worry that a G-tube may cause their child discomfort, inconvenience, or be perceived as “different.”

Optimal Timing Is Before the Age of 2

The study showed a clear correlation between the age of G-tube placement and outcomes. Overall, Wall found that G-tube placement was most successful before substantial malnourishment occurred and before the age of 2.

“When kids got their G-tube placed earlier, their lung function was better in the long run. If kids with significant or moderate malnutrition had G-tubes placed by the age of 2, they had much higher lung function whenever they were able to be tested than those who waited to get a tube placement after the age of 2,” says Wall.

G-Tubes More Than a Last Resort

Research indicates that rather than a last resort, the decision to place a G-tube is best made earlier. “Certainly, it’s wise to think about G-tubes early on, rather than letting a child struggle and waiting to see if they get better,” says Wall. “The important thing to remind families is that even with a G-tube, kids can still eat on their own. They can still do things. We just need to help them along if they’re not taking in enough calories.”

Since this research, great advancements have occurred in the treatment and management of CF.

“This study was done before Trikafta came out and revolutionized everything,” says Wall. “But there are about 10% of CF patients who don’t qualify for this medication, and it’s not readily available outside of the U.S. and North America. We are fortunate that we have access to these medications in the U.S., but there are a lot of places around the world that don’t, so hopefully this research can help guide some of their practices.”

To find out more about G-tube placement and nutritional recovery in children with CF, read Dr. Wall’s full research.