External Leakage from Feeding Gastrostomies in Patients Receiving Valproate Sprinkle

Summary: We reviewed the incidence of external leakage from feeding gastrostomies in 8 patients who received valproate sprinkle (VPA‐S). We also identified a control group of 31 children with feeding gastrostomies who were also cared for in our clinic, but who did not receive VPA‐S. All patients in both groups have had their feeding gastrostomy ≥6 months. Four of 8 children who received VPA‐S through feeding gastrostomies developed problems with recurrent external leakage. The incidence of external leakage in our control group of children who had not received VPA‐S was 2 in 31 (6.4%). We hypothesize that the external leakage is caused by adherence of the undissolved VPA‐S particles to the exterior of the tube, preventing close approximation of the tube to the gastrostomy stoma. In most cases, VPA‐S could continue to be administered and the problem of leakage reduced if the tubes were more frequently changed and/or a larger size were used. Complications with either leakage or occlusion were noted in all patients with the button feeding tube who had received VPA‐S. Because of the especially high complication rate associated with administration of VPA‐S in children with the “button” feeding tubes, we discourage VPA‐S administration to children with that device.