Aerodigestive Center, Center for Motility and Functional Gastrointestinal Disorders, Division of Gastroenterology, Hepatology & Nutrition, Boston Children's Hospital, Boston, MA.
J Pediatr Gastroenterol Nutr. 2022 Mar 1;74(3):419-423. doi: 10.1097/MPG.0000000000003308.
To determine the impact of free water administration on clinical outcomes in medically complex patients, based on the hypothesis that patients receiving more thin liquids have worse outcomes related to increased risk of gastroesophageal reflux.
This was a retrospective chart review of children initiated on commercial blenderized tube feedings from 2010 to 2019. The percentage of gastrostomy intake that was a thin liquid was determined, with thin liquids including free water or thin formula based on the International Dysphagia Diet Standardization Initiative (IDDSI) framework. Patients were categorized into those receiving low volumes of thin liquids ("percent thin" ≤20%) and those receiving higher volumes ("percent thin" >20%). Emergency room visits, hospital admissions, and chest X-rays during the year after starting the blend were compared.
Forty-five patients age 12 months to 18.7 years (median 3.7 years) were included. Twenty patients (44%) were receiving a blend with an IDDSI-categorized thin consistency and 25 patients (56%) were receiving a thicker blend. In addition to the blend, patients received a median of 320 mL per day of water (range 0-1000 mL). Patients receiving <20% thin liquids were less likely to undergo chest X-rays during follow-up than patients receiving larger amounts of thin liquids (10% in the minimal thin group versus 48% in the greater thin group, P = 0.03). In a multivariable logistic regression, this relationship remained significant after controlling for underlying pulmonary disease, aspiration, method of feed administration (bolus or continuous feeds), fundoplication status, and oral intake status.
Our study demonstrates that patients on blenderized tube feeds receive widely variable amounts of added thin liquids, like water. The addition of water to tube feeds, while typically given for hydration, can modify feed viscosity and clinical outcomes, such as chest X-ray performance.
根据患者接受更多稀薄液体与胃食管反流风险增加相关的不良结局这一假设，确定给予自由水对复杂医学患者临床结局的影响。
本研究为回顾性图表审查，纳入 2010 年至 2019 年期间开始接受商业搅拌机管饲的儿童。根据国际吞咽障碍饮食标准化倡议（IDDSI）框架，确定胃造口术摄入物中稀薄液体的百分比，稀薄液体包括自由水或稀薄配方。根据接受稀薄液体量的多少将患者分为接受低量稀薄液体（“稀薄液体百分比”≤20%）和高量稀薄液体（“稀薄液体百分比”>20%）的患者。比较开始混合喂养后一年内急诊就诊、住院和胸部 X 射线的情况。
纳入 45 名年龄 12 个月至 18.7 岁（中位数 3.7 岁）的患者。20 名（44%）患者接受 IDDSI 分类为稀薄一致性的混合物，25 名（56%）患者接受较稠的混合物。除了混合物外，患者平均每天还接受 320 毫升水（范围 0-1000 毫升）。与接受大量稀薄液体的患者相比，接受<20%稀薄液体的患者在随访期间进行胸部 X 射线检查的可能性较小（极小稀薄组为 10%，较大稀薄组为 48%，P=0.03）。在多变量逻辑回归中，在控制潜在肺病、吸入、喂养方式（推注或连续喂养）、胃底折叠术状态和口服摄入状态后，这种关系仍然显著。
本研究表明，接受搅拌机管饲的患者接受了广泛不同量的添加稀薄液体，如水分。将水加入管饲，虽然通常是为了补水，但可以改变喂养物的黏度和临床结局，如胸部 X 射线的表现。
