Enhancing Pediatric Tube Weaning with Remote Patient Monitoring: A Pilot Quasi-Experimental Study

Objective: Feeding-tube weaning is conducted in both inpatient and outpatient settings, with significant logistical, financial, and structural barriers to both approaches. We sought to assess whether remote patient monitoring (RPM), using a mobile application, which would overcome many of these barriers, could be effective in helping patients tube wean. Methods: We prospectively enrolled patients with a feeding tube, aged 0-3 years. Enrolled families entered data daily into the remote application. Data were monitored by a nurse and reviewed weekly by a multidisciplinary team. A standard hunger provocation protocol was used, paired with medical, behavioral, oral motor, and nutrition interventions, as needed. We conducted a retrospective chart review to identify a comparison cohort. The chart review was collected first, then compared to the prospective, non-randomized trial of RPM tube weaning. Results: The chart review identified 141 children seen with a feeding tube from January 2023-June 2023. Of those, 17 children attempted a tube wean. The post-intervention group consisted of 38 children prospectively enrolled from the same clinic between November 2023-2024. In the pre-intervention group, 41% of the children (7/17) were successful in achieving all calories by mouth and 90% of children (34/38) in the post-intervention group were successful in tube weaning. Conclusions: RPM is a feasible and incredibly promising model for feeding-tube weaning in pediatric patients with a wide range of medical comorbidities, including patients with multiple comorbidities. RPM allowed for high-quality medical monitoring and for a dynamic intervention in response to patient data transferred to the medical team in real time.