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Telemedicine follow-up and nutritional outcomes in children with neurological impairment: a longitudinal study
Francesca Eletti1,2, Veronica Perico1,2, Alessandro Visioli2
1Department of Biomedical and Clinical Sciences, University of Milan, Milan, Italy.
Insights
Telemedicine follow-up did not significantly alter nutritional outcomes in children with neurological impairment. However, lower baseline body mass index (BMI) z-scores predicted nutritional worsening, suggesting a need for closer monitoring in these patients.
Area of Science:
- Pediatric Nutrition
- Neurology
- Health Services Research
Background:
- Children with neurological impairment face high malnutrition risks, necessitating consistent nutritional monitoring.
- The role of telemedicine in supporting follow-up visits for this population and its effect on nutritional status is not well-established.
Purpose of the Study:
- To assess the impact of telemedicine on nutritional outcomes in children with neurological impairment.
- To identify clinical predictors of nutritional deterioration in this cohort.
Main Methods:
- A longitudinal observational study involving 152 children with neurological impairment.
- Comparison of standard in-person follow-up versus combined in-person and telemedicine visits.
- Nutritional status assessed via body mass index (BMI) z-score; multivariable logistic regression used to identify worsening predictors.
Main Results:
- No significant differences in BMI z-score, nutritional status, or outcomes between telemedicine and standard care groups.
- Baseline BMI z-score was significantly associated with nutritional worsening (OR 1.23, 95% CI 1.04-1.50).
- Telemedicine, age, percutaneous endoscopic gastrostomy (PEG), GMFCS severity, and follow-up duration were not associated with worsening.
Conclusions:
- Baseline BMI z-score is a key predictor of nutritional decline in neurologically impaired children.
- Telemedicine did not show a significant impact on nutritional outcomes compared to standard care, though baseline differences limit direct comparison.
- Telemedicine presents a potentially viable supplementary tool for managing nutritionally vulnerable pediatric patients.
Background:
Children with neurological impairment are at high risk of malnutrition and require regular nutritional monitoring. Telemedicine has been increasingly used to support follow-up visits, but its impact on nutritional outcomes remains unclear.
Methods:
We conducted a longitudinal observational study including 152 children with neurological impairment. Patients received either standard in-person follow-up or a combination of in-person and telemedicine visits. Nutritional status was assessed using body mass index (BMI) z-score at baseline and follow-up. Nutritional outcome was classified as improved, stable, or worsened based on changes in BMI z-score. The aim of this study was to evaluate the association between telemedicine follow-up and nutritional outcomes and to identify clinical factors associated with nutritional worsening. Multivariable logistic regression was performed to identify predictors of nutritional deterioration.
Results:
At baseline, children in the telemedicine group were younger and had a higher prevalence of percutaneous endoscopic gastrostomy (PEG) (p = 0.013), while no differences were observed in gross motor function classification system (GMFCS) severity or baseline nutritional status. No significant differences were observed between groups in BMI z-score at follow-up (p = 0.877), change in BMI z-score (p = 0.458), nutritional status at follow-up (p = 0.356), or nutritional outcome (p = 0.329). In multivariable analysis, baseline BMI z-score was associated with nutritional worsening (OR 1.23, 95% CI 1.04-1.50; p = 0.013), whereas telemedicine follow-up (p = 0.166), age (p = 0.767), PEG (p = 0.869), GMFCS severity (p = 0.704), and follow-up duration (p = 0.352) were not associated with worsening.
Conclusion:
Baseline BMI z-score was the only variable independently associated with nutritional worsening during follow-up. No statistically significant differences in nutritional outcomes were observed between telemedicine and standard care groups; however, differences in baseline characteristics limit direct comparability. Telemedicine may represent a feasible and complementary approach to support follow-up in nutritionally vulnerable pediatric patients.
