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Published on: August 21, 2015
An Exploratory Assessment on Differing Supplemental Feeding Methods and Associated Pediatric Neurorehabilitation
Jennifer Wu1,2, Lea C Mason1,3, Patricia A Orme1,4
1Division of Pediatric Rehabilitation Medicine, Spaulding Rehabilitation Hospital, Boston, MA.
Objective:
To identify functional differences of continued nasogastric tube (NG) compared with new gastrostomy (GT) tube for enteral feeding support in pediatric neurorehabilitation patients admitted to inpatient rehabilitation (IPR).
Design:
Retrospective cohort study.
Setting:
Pediatric IPR facility.
Participants:
A total of 74 children and adolescents (N=74) (47 boys/27 girls, age mean ± SD=10.7±5.1y) with new neurologic impairments because of acquired brain injury and admitted to pediatric IPR with either NG or new GT tube for supplemental feeding.
Interventions:
Standard of care IPR treatment.
Main Outcome Measures:
The primary outcome measure was the change in International Dysphagia Diet Standardisation Initiative Functional Diet Scale (IDDSI-FDS) score at IPR admission and discharge. Secondary outcome measures included the cognitive components of the Functional Independence Measure in Children (WeeFIM) and body mass index.
Results:
At admission, rates of continued NG (51%) and new GT (49%) were similar. IPR treatment resulted in statistically significant improvements in eating function (IDDSI-FDS score median [interquartile range], 0 [0-2.25] to 8 [4.75-8] points; χ2=44.9; P<.001) and cognitive function (WeeFIM Cognition subtotal score mean ± SD=12.2±6.5 to 19.4±7.9 points, t=9.25, P<.001). For nil per os patients, admission with GT was associated with a higher discharge IDDSI-FDS discharge score (GT=7 [0-8] vs NG=5 [0.75-8]; χ2=11.1; P=.09) and a larger effect size in score change across all WeeFIM Cognition components. In contrast, NG was associated with lower body mass index at admission and lesser weight gain across IPR treatment.
Conclusions:
Feeding tube type at IPR admission may be correlated with functional outcome at discharge home in patients with new neurologic impairments because of acquired brain injury.