Safety of Appetite Manipulation in Children with Feeding Disorders Admitted to an Inpatient Feeding Program

ABSTRACT Objectives: Appetite manipulation can be effective in weaning children off gastrostomy tube (G-tube) feeding dependence but can cause dehydration, hypoglycemia and ketone body production, which is anorexigenic. Since the safety of this approach has not been described, our aim was to describe adverse events observed when weaning children from G-tube dependence using our appetite manipulation protocol. Methods: This was a retrospective study of prospectively collected data of patients who completed our inpatient tube-weaning protocol. Daily safety parameters included twice-daily urine specific gravities and urine ketones and fasting capillary blood glucose. Graded clinical interventions to manage adverse events were collected. Results: 143 children with a mean age of 4.8 ± 2.4 years were seen in the inpatient feeding program of which 74 (51.7%) were male. The children were hospitalized 10.1 ± 2.5 days with the vast majority being discharged between days 11 and 14. Overall, 78.2% of patients experienced at least one adverse event: urine specific gravity > 1.020 was seen in 60.5%, ketonuria in 48.9%, and hypoglycemia (≤60 mg/dL) in 13.4%. Only two children had blood glucose levels 

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