Maireade E McSweeney1, Jessica Kerr1, Janine Amirault1, Paul D Mitchell2, Kara Larson1, Rachel Rosen3. 1. Aerodigestive Center, Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA. 2. Clinical Research Center, Boston Children's Hospital, Boston, MA. 3. Aerodigestive Center, Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Hepatology and Nutrition, Boston Children's Hospital, Boston, MA. Electronic address: Rachel.Rosen@childrens.harvard.edu.
Abstract
OBJECTIVE: To compare the frequency of hospitalization rates between patients with aspiration treated with gastrostomy vs those fed oral thickened liquids. STUDY DESIGN: A retrospective review was performed of patients with an abnormal videofluoroscopic swallow study between February 2006 and August 2013; 114 patients at Boston Children's Hospital were included. Frequency, length, and type of hospitalizations within 1 year of abnormal swallow study or gastrostomy tube (g-tube) placement were analyzed using a negative binomial regression model. RESULTS: Patients fed by g-tube had a median of 2 (IQR 1, 3) admissions per year compared with patients fed orally who had a 1 (IQR 0, 1) admissions per year, P < .0001. Patients fed by gastrostomy were hospitalized for more days (median 24 [IQR 6, 53] days) vs patients fed orally (median 2 [IQR 1, 4] days, [P < .001]). Despite the potential risk of feeding patients orally, no differences in total pulmonary admissions (incidence rate ratio 1.65; 95% CI [0.70, 3.84]) between the 2 groups were found, except patients fed by g-tube had 2.58 times (95% CI [1.02, 6.49]) more urgent pulmonary admissions. CONCLUSIONS: Patients who underwent g-tube placement for the treatment of aspiration had 2 times as many admissions compared with patients with aspiration who were fed orally. We recommend a trial of oral feeding in all children cleared to take nectar or honey thickened liquids prior to g-tube placement.
OBJECTIVE: To compare the frequency of hospitalization rates between patients with aspiration treated with gastrostomy vs those fed oral thickened liquids. STUDY DESIGN: A retrospective review was performed of patients with an abnormal videofluoroscopic swallow study between February 2006 and August 2013; 114 patients at Boston Children's Hospital were included. Frequency, length, and type of hospitalizations within 1 year of abnormal swallow study or gastrostomy tube (g-tube) placement were analyzed using a negative binomial regression model. RESULTS:Patients fed by g-tube had a median of 2 (IQR 1, 3) admissions per year compared with patients fed orally who had a 1 (IQR 0, 1) admissions per year, P < .0001. Patients fed by gastrostomy were hospitalized for more days (median 24 [IQR 6, 53] days) vs patients fed orally (median 2 [IQR 1, 4] days, [P < .001]). Despite the potential risk of feeding patients orally, no differences in total pulmonary admissions (incidence rate ratio 1.65; 95% CI [0.70, 3.84]) between the 2 groups were found, except patients fed by g-tube had 2.58 times (95% CI [1.02, 6.49]) more urgent pulmonary admissions. CONCLUSIONS:Patients who underwent g-tube placement for the treatment of aspiration had 2 times as many admissions compared with patients with aspiration who were fed orally. We recommend a trial of oral feeding in all children cleared to take nectar or honey thickened liquids prior to g-tube placement.
Authors: Daniel R Duncan; Janine Amirault; Nikki Johnston; Paul Mitchell; Kara Larson; Rachel L Rosen Journal: J Pediatr Gastroenterol Nutr Date: 2016-08 Impact factor: 2.839
Authors: Daniel R Duncan; Janine Amirault; Paul D Mitchell; Kara Larson; Rachel L Rosen Journal: J Pediatr Gastroenterol Nutr Date: 2017-08 Impact factor: 2.839
Authors: Daniel R Duncan; Paul D Mitchell; Kara Larson; Maireade E McSweeney; Rachel L Rosen Journal: JAMA Otolaryngol Head Neck Surg Date: 2018-12-01 Impact factor: 6.223
Authors: Maireade E McSweeney; Jessica Kerr; Janine Amirault; Eliza Fishman; Margot Lurie; Maria I Peinado-Fabregat; Paul D Mitchell; Rachel Rosen Journal: J Pediatr Gastroenterol Nutr Date: 2018-06 Impact factor: 2.839
Authors: Nasser H Kashou; Irfaan A Dar; Mohamed A El-Mahdy; Charles Pluto; Mark Smith; Ish K Gulati; Warren Lo; Sudarshan R Jadcherla Journal: Front Pediatr Date: 2017-04-10 Impact factor: 3.418