An Exploratory Assessment on Differing Supplemental Feeding Methods and Associated Pediatric Neurorehabilitation Outcomes.
Jennifer Wu, Lea C Mason, Patricia A Orme and 6 others
PMID 42769644WHAT IT FOUND
Children and teens after acquired brain injury improved diet level during inpatient rehabilitation.
Among those nil by mouth at admission, gastrostomy tube status was associated with larger cognitive gains, but tube choice was not random.
Key findings
01The 74 patients improved diet level during inpatient rehabilitation, with median diet score moving from 0, meaning nil by mouth, to 8, meaning regular solid food and thin liquids.
02Among the 52 patients who were nil by mouth at admission, discharge diet scores were higher with a gastrostomy tube (median 7 versus 5; P=.09), and gastrostomy tube status was associated with larger cognition score changes.
03Nasogastric tube status at admission was associated with more frequent plain radiographs to check tube positioning (P=.004).
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How it was doneWhat they foundWhat it means for SLPs
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What it does not show
This was a retrospective chart review at one pediatric inpatient rehabilitation hospital, so it cannot show that a gastrostomy tube caused better outcomes. Tube type was not randomly assigned; it reflected clinical decisions made in acute care, so children chosen for gastrostomy may have differed in ways that also affected rehabilitation. The study included only patients with acquired brain injury who needed supplemental enteral feeding, so results do not apply to children in rehabilitation without brain injury or feeding tubes. Several important comparisons had P values above the 0.05 threshold, including the discharge diet score comparison among nil-by-mouth patients (P=.09) and BMI and weight gain comparisons (P=.07 and P=.2). Unmeasured factors such as injury severity, airway status, preinjury developmental function, swallow study findings, and center-specific gastrostomy thresholds may have biased results. Institutional differences in gastrostomy placement indications, availability, and rehabilitation program use affect generalizability.
Declared interests
The investigators reported no financial or nonfinancial disclosures.
The easy way to misread this
Do not conclude that a gastrostomy tube improves feeding, cognition, or weight outcomes. Tube type was chosen by acute care clinicians, not randomly assigned, and patients selected for gastrostomy may have differed in injury severity or other factors. The feeding comparison among nil-by-mouth patients also had P=.09 with a significance threshold of 0.05.