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Peer-reviewedCC BY 4.0Frontiers in Pediatrics

Outcomes of gastrostomy in children with neurological impairment: a systematic review

  • Mariam Kamel Ibrahim1
  • Hafeeza Jummakhan1
  • Malak Dawood1
  • Mariam Siam1
  • Minat Allah Alhusami1
  • Sara Khan1
  • Jonathan Mokhtar1,2
  • Hani T. S. Benamer1
  • Mohamed O. E. Babiker1,3
  1. 1College of Medicine, Mohammed Bin Rashid University of Medicine and Health Sciences, Dubai Health, Dubai, United Arab Emirates
  2. 2Research and Graduate Studies, Mohammed Bin Rashid University of Medicine and Health Sciences (MBRU), Dubai Health, Dubai, United Arab Emirates
  3. 3Pediatrics, Dubai Health, Dubai, United Arab Emirates
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Abstract

Introduction: Gastrostomy feeding is widely used for children with neurological impairment and inadequate oral intake, but evidence across family-important outcomes has not been synthesised. Previous systematic reviews were restricted to cerebral palsy and found no controlled studies. The objective of this study is to assess gastrostomy vs. continued oral/nasogastric feeding on nutritional, respiratory, neurodevelopmental, and caregiver-reported outcomes, and to quantify complications.

Methods: A PROSPERO-registered systematic review (CRD420261483110) was conducted following PRISMA 2020 guidelines. Five databases were searched to 15 July 2026 for children aged 0-18 with neurological impairment undergoing gastrostomy. Duplicate screening, data extraction, and risk-of-bias appraisal (RoB 2, ROBINS-I, JBI, CASP) were performed. Heterogeneity precluded meta-analysis; narrative synthesis prioritized study design and methodological quality over direction-of-effect vote counting.

Results: From 5,503 records, 120 studies (≈117 cohorts, 30 countries) met the criteria. The evidence was predominantly observational, and most comparative studies carried a serious risk of bias. Nutritional status improved in the majority of 56 studies, though earlier placement's association with more robust catch-up growth does not establish causality. Among 56 respiratory studies, smaller cohorts reported fewer infections, but the largest propensity-matched and population-linked datasets showed no reduction, and in some analyses an increase, in pneumonia hospitalisations. Minor complications were common (20%–95%). Major complications clustered at 0%–3% without concurrent antireflux surgery, but rose several-fold when fundoplication or jejunal extensions were added. Reflux outcomes (59 studies) depended on preoperative status; it is hypothesized from limited physiological data that gastrostomy may increase de novo reflux risk in previously reflux-free children, though <10% required subsequent antireflux surgery. All-cause mortality (67 studies) was high but disease-related; procedure-attributable death was rare, and 30-day mortality was 0%–3% outside the most fragile groups. Quality-of-life data (21 studies) showed favourable caregiver outcomes in 14/17 studies, but the child's quality of life has been measured properly only once and was unchanged. Only 11 studies addressed neurodevelopment; the single study using a standardised instrument found cognitive recovery unrelated to the feeding route.

Discussion: Gastrostomy is consistently associated with improved weight-based nutritional status and carries low serious surgical harm when performed without concurrent antireflux surgery. It does not eliminate aspiration risk and is hypothesized to increase de novo reflux risk in previously reflux-free children. Caregiver quality of life improves on validated measurement; however, the available evidence is insufficient to determine whether gastrostomy has a favourable, unfavourable, or neutral effect on a child's neurodevelopment.

Systematic Review Registration: PROSPERO: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261483110.

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Cite

BibTeXRIS
BibTeX
@article{ibrahim2026outcomes,
  title = {{Outcomes of gastrostomy in children with neurological impairment: a systematic review}},
  author = {Mariam Kamel Ibrahim and Hafeeza Jummakhan and Malak Dawood and Mariam Siam and Minat Allah Alhusami and Sara Khan and Jonathan Mokhtar and Hani T. S. Benamer and Mohamed O. E. Babiker},
  journal = {Frontiers in Pediatrics},
  year = {2026},
  month = oct,
  doi = {10.3389/fped.2026.1963093},
  url = {https://doi.org/10.3389/fped.2026.1963093},
  note = {CC BY 4.0},
}
RIS
TY  - JOUR
TI  - Outcomes of gastrostomy in children with neurological impairment: a systematic review
AU  - Mariam Kamel Ibrahim
AU  - Hafeeza Jummakhan
AU  - Malak Dawood
AU  - Mariam Siam
AU  - Minat Allah Alhusami
AU  - Sara Khan
AU  - Jonathan Mokhtar
AU  - Hani T. S. Benamer
AU  - Mohamed O. E. Babiker
PY  - 2026
DA  - 2026/10/12
JO  - Frontiers in Pediatrics
DO  - 10.3389/fped.2026.1963093
UR  - https://doi.org/10.3389/fped.2026.1963093
AB  - Introduction: Gastrostomy feeding is widely used for children with neurological impairment and inadequate oral intake, but evidence across family-important outcomes has not been synthesised. Previous systematic reviews were restricted to cerebral palsy and found no controlled studies. The objective of this study is to assess gastrostomy vs. continued oral/nasogastric feeding on nutritional, respiratory, neurodevelopmental, and caregiver-reported outcomes, and to quantify complications.  Methods: A PROSPERO-registered systematic review (CRD420261483110) was conducted following PRISMA 2020 guidelines. Five databases were searched to 15 July 2026 for children aged 0-18 with neurological impairment undergoing gastrostomy. Duplicate screening, data extraction, and risk-of-bias appraisal (RoB 2, ROBINS-I, JBI, CASP) were performed. Heterogeneity precluded meta-analysis; narrative synthesis prioritized study design and methodological quality over direction-of-effect vote counting.  Results: From 5,503 records, 120 studies (≈117 cohorts, 30 countries) met the criteria. The evidence was predominantly observational, and most comparative studies carried a serious risk of bias. Nutritional status improved in the majority of 56 studies, though earlier placement's association with more robust catch-up growth does not establish causality. Among 56 respiratory studies, smaller cohorts reported fewer infections, but the largest propensity-matched and population-linked datasets showed no reduction, and in some analyses an increase, in pneumonia hospitalisations. Minor complications were common (20%–95%). Major complications clustered at 0%–3% without concurrent antireflux surgery, but rose several-fold when fundoplication or jejunal extensions were added. Reflux outcomes (59 studies) depended on preoperative status; it is hypothesized from limited physiological data that gastrostomy may increase de novo reflux risk in previously reflux-free children, though <10% required subsequent antireflux surgery. All-cause mortality (67 studies) was high but disease-related; procedure-attributable death was rare, and 30-day mortality was 0%–3% outside the most fragile groups. Quality-of-life data (21 studies) showed favourable caregiver outcomes in 14/17 studies, but the child's quality of life has been measured properly only once and was unchanged. Only 11 studies addressed neurodevelopment; the single study using a standardised instrument found cognitive recovery unrelated to the feeding route.  Discussion: Gastrostomy is consistently associated with improved weight-based nutritional status and carries low serious surgical harm when performed without concurrent antireflux surgery. It does not eliminate aspiration risk and is hypothesized to increase de novo reflux risk in previously reflux-free children. Caregiver quality of life improves on validated measurement; however, the available evidence is insufficient to determine whether gastrostomy has a favourable, unfavourable, or neutral effect on a child's neurodevelopment.  Systematic Review Registration: PROSPERO: https://www.crd.york.ac.uk/PROSPERO/view/CRD420261483110.
SN  - 2296-2360
ER  -