Telemedicine follow-up and nutritional outcomes in children with neurological impairment: a longitudinal study.

BACKGROUND

Children with neurological impairment are at high risk of malnutrition and require regular nutritional monitoring. Telemedicine has been increasingly used to support follow-up visits, but its impact on nutritional outcomes remains unclear.

METHODS

We conducted a longitudinal observational study including 152 children with neurological impairment. Patients received either standard in-person follow-up or a combination of in-person and telemedicine visits. Nutritional status was assessed using body mass index (BMI) z-score at baseline and follow-up. Nutritional outcome was classified as improved, stable, or worsened based on changes in BMI z-score. The aim of this study was to evaluate the association between telemedicine follow-up and nutritional outcomes and to identify clinical factors associated with nutritional worsening. Multivariable logistic regression was performed to identify predictors of nutritional deterioration.

RESULTS

At baseline, children in the telemedicine group were younger and had a higher prevalence of percutaneous endoscopic gastrostomy (PEG) (p = 0.013), while no differences were observed in gross motor function classification system (GMFCS) severity or baseline nutritional status. No significant differences were observed between groups in BMI z-score at follow-up (p = 0.877), change in BMI z-score (p = 0.458), nutritional status at follow-up (p = 0.356), or nutritional outcome (p = 0.329). In multivariable analysis, baseline BMI z-score was associated with nutritional worsening (OR 1.23, 95% CI 1.04-1.50; p = 0.013), whereas telemedicine follow-up (p = 0.166), age (p = 0.767), PEG (p = 0.869), GMFCS severity (p = 0.704), and follow-up duration (p = 0.352) were not associated with worsening.

CONCLUSION

Baseline BMI z-score was the only variable independently associated with nutritional worsening during follow-up. No statistically significant differences in nutritional outcomes were observed between telemedicine and standard care groups; however, differences in baseline characteristics limit direct comparability. Telemedicine may represent a feasible and complementary approach to support follow-up in nutritionally vulnerable pediatric patients.