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Associations Between Enteral Nutrition and Acute Respiratory Infection Among Patients in New York Metropolitan Region
Marissa Burgermaster1, Meghan Murray2, Lisa Saiman3,4
1Division of Preventive Medicine and Nutrition, Department of Medicine, Columbia University Medical Center, New York, New York, USA.
Insights
Enteral nutrition (EN) in pediatric long-term care facilities is linked to increased acute respiratory infections (ARI) and lower home discharge rates. Specialized infant care may be needed for better outcomes.
Area of Science:
- Pediatric critical care
- Clinical nutrition
- Healthcare outcomes research
Background:
- Pediatric long-term care facilities (pLTCF) manage complex patients requiring significant nutrition support.
- The impact of nutrition support on outcomes in pLTCF residents remains unclear.
- This study examines nutrition support and outcomes in metropolitan New York pLTCF, including a specialized infant feeding unit.
Purpose of the Study:
- To describe the relationship between nutrition support and clinical outcomes in pediatric long-term care residents.
- To investigate associations between enteral nutrition (EN) and acute respiratory infections (ARI) and home discharge rates.
- To explore differences in outcomes for infants in a specialized feeding disorders unit.
Main Methods:
- Prospective cohort study of 720 residents and 208 infants in three pLTCF.
- Logistic regression analysis to assess the relationship between EN and ARI.
- Multivariable models controlled for comorbidities and infection history.
Main Results:
- Residents receiving EN had more comorbidities.
- EN was associated with a 65% increased incidence of ARI (IRR = 1.65, p < .001).
- Among infants, percutaneous feeding tubes were linked to higher ARI risk (IRR = 1.94, p < .01), and EN was associated with lower odds of home discharge (OR = 0.45, p < .01).
Conclusions:
- Enteral nutrition is prevalent and crucial in pLTCF due to patient complexity and long-term needs.
- Distinct EN types and outcomes in infants suggest a need for tailored care strategies.
- Findings offer insights for enhancing care quality and education for clinicians and caregivers in pLTCF.
Background:
Pediatric long-term care facilities (pLTCF) serve a complicated and resource-intensive patient population with high usage of nutrition support. However, the relationship between nutrition support and outcomes among pLTCF residents is not well understood. We described this relationship in three metropolitan New York pLTCF and a subsample of infants from one of these facilities with a feeding disorders unit.
Methods:
In this prospective cohort study, we used logistic regression to assess relationships between enteral nutrition (EN), and acute respiratory infections (ARI) among residents (n = 720, 50% male, mean age = 5.5 years, mean number comorbidities = 2.1) and infant subsample (<1 year, n = 208, 50% male, mean number comorbidities = 2.0). We tested these associations in multivariable models controlling for numbers of comorbidities and infections.
Results:
Many residents received nutrition via percutaneous (59%) or nasogastric (15%) feeding tubes. In univariate analyses, residents receiving EN had more comorbidities. In multivariable analyses, EN was associated with ARI (incidence rate ratio = 1.65, p < .001). Among infants in the specialized unit, greater risk of ARI was associated only with percutaneous (incidence rate ratio = 1.94, p < .01) feeding. EN was associated with lower odds of being discharged home (OR = 0.45, p < .01).
Conclusion:
The prevalence of EN, complexity of cases, and necessity of long-term EN make nutrition support important in pLTCFs. Differences in EN types and adverse outcomes in the infant subsample suggest different care is necessary for this subpopulation. Results provide context for improving quality of care and clinician/caregiver education for this population.
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