OC60 Temporal trends in complex feeding decisions a decade in a specialist clinic in a tertiary paediatric setting

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Decision making for patients with complex feeding issues have previously been made in isolation. It is advocated for cohesive decisions to be made in a multidisciplinary setting.1 Since the 2013 appointment of a nurse specialist, complex feeding decisions are made in our tertiary MDT complex enteral feeding (CEN) clinic. We aim to describe clinical outcomes with reference to changes in medical and surgical therapies. From a prospectively gathered departmental database, all patients reviewed in CEN clinic (03/2013–12/2022) were assessed for: demographics; primary diagnosis; referral mode. Interventions of interest: fundoplication; jejunal feeding; blenderised diet (BD). Patients commenced on jejunal feeding or BD each year were calculated. Comparison of proportionate interventions for when dietetic support for BD was and was not resourced was performed by fisher’s exact test (sig p≤0.05). Of 201 patients reviewed: 61% had a severe neurodisability; 26% multisystem disease; 7% complex GI surgery; 4% complex cardiology; 2% isolated complex feeding issue. 62% male, median age at referral was 3.3 years. 58 fundoplications were performed, 99 received jejunal feeding (initiated with 37 nasojejunal; 58 gastrojejunal device; 4 surgical jejunostomy) and 57 patients of the 72 recommended started BD. BD has been advocated by team since 2016 as a feeding strategy for gastric intolerance of milk formula. Dietetic support to establish BD was resourced 2018–2020. Out-with this timeframe, availability was limited in certain areas. After rising incident cases of jejunal feeding, we observed a reduction with the introduction of dietetic resource to support BD initiation (2018–2020). This trend was reversed 2021–2022 with significantly higher jejunal initiation being required (p=0.0005) (figure 1). We observe a reduction in fundoplication from 11 to 3 per year, in line with increased in jejunal feeding and BD. A small minority required a period of parenteral nutrition (PN) support including 2 patients who received PN for > 12 months. We report the longitudinal trends in intervention in a CEN clinic with reduction of fundoplication and rise then reduction in jejunal feeding when dietetic support for BD was available. The reduction in BD initiation 2021–2022 sits chronologically with the withdrawal of dietetic support and resulted in significant rise in jejunal feeding. We highlight the success of fundoplication for patients in our service with careful selection. This has driven service redesign within our institution. Jejunal feeding has become secondary to a trial of BD in our hierarchy due to BD benefits including: less invasive feeding modality; apparent better symptom control; parental wishes and cost saving. Effects of the pandemic and dietetic resource may have restricted access to BD in the last 2 years. Reference Broekaert IJ, Falconer J, et al. JPGN. 2019 Aug;69(2):239–258.

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