Summative table

Author and Year, Study Design, Class

Study Purpose

Study Population

Interventions

Results*

Conclusions

Strengths & Limitations

Oh et al 20188

Before-After

Class D

Assess growth and nutritional status changes after Nissen fundoplication in children with NI and GERD.

Assess changes in hospital visitation scores associated with reflux.

N=76 children (n=44 males) with NI requiring Nissen fundoplication for GERD

GT n=46

Median age at operation: 1.85 yrs (2 d –18 yrs)

Location:

Seoul, Korea

Pre and post- fundoplication assessment of:

Nutrition status

Measurements

wt/age z-score

ht/age z-score

BMI/age z-score

Serum albumin protein levels

Hospital visitation scores

Median follow-up=23 M (12-168)

Significant improvements in:

Wt/age z-score (pre –2.42+2.19 post –1.31+1.96, p<0.001)

Ht/age z-score (pre -1.6+2.16 post –1.05+1.69, p=0.002)

BMI/age z-score (pre -2.07+2.99 post-0.89+.21 p<0.001)

GT sub-analysis

Significant increase in ht/age z-score (pre -1.7+2.6, post –0.95+1.92, p=0.025) although increase not significant between children with and without GT (p=0.115)

Among children with NI weight status increased post-fundoplication.

Strengths

Use of z-scores

Limitations

Single center study

Small sample size

Mauritz et al9 2017

Before-After

Class D

Assess the outcomes of LARS among pediatric patients.

Identify factors that predict LARS failure.

N=25 children (n=12 males) with PPI resistant GERD treated at 1 of 3 centers.

Median age at operation: 6 yrs (3-11)

Location: Netherlands

Pre and post-LARS assessment of:

Nutrition status

ht/age z-score

wt/ht z-score

24-h MII-pH

Reflux specific questionnaire

GE

13C-labled Na-octanoate breath test

Follow-up=3 M

There was no significant difference in ht/age or wt/ht z-scores pre to 3 M post-operatively.

Weight status did not significantly increase post-fundoplication.

Strengths

Use of z-scores

Multi-center study

Limitations

Small sample size

Unknown number of patients with GT

Jensen et al10 2015

Before-After

Class D

Among those with BPD:

Compare characteristics of those with and without history of anti-reflux surgery

Assess changes in clinical characteristics post-anti-reflux surgery

Secondary aim: Assess post-operative nutrition and respiratory outcomes

N=50 with BPD + GERD

n=22 BPD + GERD + surgery

GT=22

Location: Philadelphia, PA

Pre-fundoplication assessment of:

Wt

Post-fundoplication assessment of:

Wt (14 days after full feed rate reached)

Day feeds start

Day feeds at goal rate

Mode of respiratory support at discharge

No significant difference in rate of weight gain, when measured as g/d, pre and post-fundoplication (pre 25g/d to post 20g/d, p=0.21)

Among infants with BPD, there was no change in weight gain post-fundoplication.

Strengths

Assessment of children less than 1 year of age.

Limitations

Small sample size

Single center study

Short follow-up

Age at operation unknown

Kubiak et al11 2013

Before-After

Class D

Assess changes in weight following fundoplication in children.

Compare outcomes among:

GT and non-GT

NI and non-NI

With and without esophageal complications

N=127

(n=72 males)

NI n=84

GT n=71

Median age at operation: 3.2 yrs (0.3- 15.5)

Location: UK

Pre and post- fundoplication assessment of weight z-scores.

Median follow-up= 29.6 M (2 - 173)

Significant increase in wt z-score pre to post-operative

-1.87+0.19 to -0.97+0.17, p<0.001

GT sub-analysis

Significant increase in weight z-score pre to post

With GT (n=71): -2.80+0.22 to -1.57+0.24, p<0.001)

Without GT (n=56): -0.68+0.25 to -0.23+0.21, p=0.013

Weight status increased post-fundoplication.

Strengths

Use of z-scores

Limitations

Single center study

Secondary analysis from a RT