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.