679 - Medication Volume is Associated with Increased Risk of Aspiration Pneumonia in Patients with Gastrostomy Tube Dependence

Publication Number: 4664.679

Naaz Daneshvar, Boston Children's Hospital, Boston, MA, United States; Arda Hotz, Boston Children's Hospital, Boston, MA, United States; Rachel Rosen, Boston Children's Hospital, Boston, MA, United States

Background: Aspiration pneumonia is a common complication among children with gastrostomy tubes (g-tubes), leading to increases in the use of antibiotics, length of hospital stay, and the risk of mortality. While much of aspiration pneumonia risk modulation is focused on adjustments to enteral feeds, the contribution of medication volume to aspiration risk remains unclear.

Objective: The purpose of this study was to determine whether higher cumulative medication volume was associated with increased incidence of aspiration pneumonia risk in order to inform safer medication administration practices.

Design/Methods: We conducted a retrospective cohort study of g-tube–dependent patients seen in Boston Children’s Complex Care Clinic in January of 2024. Charts were reviewed for medication volumes, feed volumes, and comorbidities. The primary outcome was clinically diagnosed aspiration pneumonia within 1 year of index visit. Analysis was done using T-tests, chi square analysis, and logistic regression. Variables considered included common complex conditions, method of feeding (bolus vs continuous feeds), and total daily medication volume by weight.

Results: 62 patients were included in the analysis, 16 of which were found to have an aspiration pneumonia within a year of the index visit. Results are reported in Table 1. Using logistic regression to adjust for the variable significant in the univariate analyses, higher medication volume by kg weight (p =0.004) and use of continuous feeds (p =0.02) were both found to be associated with the development of aspiration pneumonias. Notably, there were no significant differences in other comorbidities, including cardiac, genetic, or cerebral palsy diagnoses, between groups.

Conclusion(s): Among G-tube–dependent pediatric patients, greater total daily liquid medication volume was associated with a higher risk of aspiration pneumonia. These findings suggest that clinicians should consider consolidating or concentrating liquid medications, switching to dissolved tablets and/or limiting unnecessary enteral medication volumes to reduce aspiration risk. Additionally, for patients with GJ tube dependence, clinicians should consider administering medications through the J port when clinically appropriate, especially for higher volume medications.

Table 1
Aspiration Table 1.pdf