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.