Oral Feeding Reduces Hospitalizations Compared with Gastrostomy Feeding in Infants and Children Who Aspirate

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.