{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,12]],"date-time":"2026-10-12T16:26:06Z","timestamp":1791822366978,"version":"4.3.4"},"reference-count":31,"publisher":"SAGE Publications","issue":"9","license":[{"start":{"date-parts":[[2021,3,22]],"date-time":"2021-03-22T00:00:00Z","timestamp":1616371200000},"content-version":"tdm","delay-in-days":0,"URL":"https:\/\/journals.sagepub.com\/page\/policies\/text-and-data-mining-license"}],"content-domain":{"domain":["journals.sagepub.com"],"crossmark-restriction":true},"short-container-title":["J Child Neurol"],"published-print":{"date-parts":[[2021,8]]},"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Gastrostomy tube (G-tube) placement for children with neurologic impairment with dysphagia has been suggested for pneumonia prevention. However, prior studies demonstrated an association between G-tube placement and increased risk of pneumonia. We evaluate the association between timing of G-tube placement and death or severe pneumonia in children with neurologic impairment.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We included all children enrolled in California Children\u2019s Services between July 1, 2009, and June 30, 2014, with neurologic impairment and 1 pneumonia hospitalization. Prior to analysis, children with new G-tubes and those without were 1:2 propensity score matched on sociodemographics, medical complexity, and severity of index hospitalization. We used a time-varying Cox proportional hazard model for subsequent death or composite outcome of death or severe pneumonia to compare those with new G-tubes vs those without, adjusting for covariates described above.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>A total of 2490 children met eligibility criteria, of whom 219 (9%) died and 789 (32%) had severe pneumonia. Compared to children without G-tubes, children with new G-tubes had decreased risk of death (hazard ratio [HR] 0.47, 95% confidence interval [CI] 0.39-0.55) but increased risk of the composite outcome (HR 1.21, CI 1.14-1.27). Sensitivity analyses using varied time criteria for definitions of G-tube and outcome found that more recent G-tube placement had greater associated risk reduction for death but increased risk of severe pneumonia.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>Recent G-tube placement is associated with reduced risk of death but increased risk of severe pneumonia. Decisions to place G-tubes for pulmonary indications in children with neurologic impairment should weigh the impact of severe pneumonia on quality of life.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1177\/08830738211000179","type":"journal-article","created":{"date-parts":[[2021,3,22]],"date-time":"2021-03-22T13:22:43Z","timestamp":1616419363000},"page":"727-734","update-policy":"https:\/\/doi.org\/10.1177\/sage-journals-update-policy","source":"Crossref","is-referenced-by-count":11,"title":["Gastrostomy Tubes Placed in Children With Neurologic Impairment: Associated Morbidity and Mortality"],"prefix":"10.1177","volume":"36","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-9964-7984","authenticated-orcid":false,"given":"Jody L.","family":"Lin","sequence":"first","affiliation":[{"name":"Division of Pediatric Hospital Medicine, Department of Pediatrics, University of Utah School of Medicine, Salt Lake City, UT, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Joseph","family":"Rigdon","sequence":"additional","affiliation":[{"name":"Department of Biostatistics and Data Science, Wake Forest School of Medicine, Winston-Salem, NC, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Keith","family":"Van Haren","sequence":"additional","affiliation":[{"name":"Division of Child Neurology, Department of Neurology and Neurological Science, Stanford University School of Medicine, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"MyMy","family":"Buu","sequence":"additional","affiliation":[{"name":"Division of Pediatric Pulmonary Medicine, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olga","family":"Saynina","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jay","family":"Bhattacharya","sequence":"additional","affiliation":[{"name":"Stanford Health Policy, Stanford University, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Douglas K.","family":"Owens","sequence":"additional","affiliation":[{"name":"Stanford Health Policy, Stanford University, Stanford, CA, USA"},{"name":"VA Palo Alto Health Care System, Palo Alto, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Lee M.","family":"Sanders","sequence":"additional","affiliation":[{"name":"Division of General Pediatrics, Department of Pediatrics, Stanford University School of Medicine, Stanford, CA, USA"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"179","published-online":{"date-parts":[[2021,3,22]]},"reference":[{"key":"bibr1-08830738211000179","doi-asserted-by":"publisher","DOI":"10.1371\/journal.pmed.1001158"},{"key":"bibr2-08830738211000179","doi-asserted-by":"publisher","DOI":"10.1001\/jama.2011.122"},{"key":"bibr3-08830738211000179","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2016-0682"},{"key":"bibr4-08830738211000179","doi-asserted-by":"publisher","DOI":"10.3928\/00904481-20100318-06"},{"key":"bibr5-08830738211000179","doi-asserted-by":"publisher","DOI":"10.1017\/S0012162200001249"},{"issue":"6","key":"bibr6-08830738211000179","first-page":"534","volume":"89","author":"Sleigh G","year":"2004","journal-title":"Arch Dis Child"},{"key":"bibr7-08830738211000179","doi-asserted-by":"publisher","DOI":"10.1111\/j.1469-8749.2003.tb00421.x"},{"issue":"7","key":"bibr8-08830738211000179","first-page":"CD003943","volume":"2013","author":"Gantasala S","year":"2013","journal-title":"Cochrane Database Syst Rev"},{"key":"bibr9-08830738211000179","doi-asserted-by":"publisher","DOI":"10.1212\/WNL.0000000000004534"},{"key":"bibr10-08830738211000179","doi-asserted-by":"publisher","DOI":"10.1542\/peds.2019-0543"},{"key":"bibr11-08830738211000179","unstructured":"HRSA. 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