For a study, researchers sought to determine how free water delivery affected clinical outcomes in medically complicated patients, with the hypothesis being that patients who received more thin liquids had worse results due to an increased risk of gastric reflux. It was a chart study of children who were started on commercial blenderized tube feedings between 2010 and 2019. Based on the International Dysphagia Diet Standardization Initiative (IDDSI) framework, the proportion of gastrostomy intake that was a thin liquid was calculated. Thin liquids included free water or thin formula. Patients were divided into two groups: those who received modest amounts of thin liquids (“percent thin” <20%) and those who received greater volumes (“percent thin” >20%). Emergency department visits, hospital admissions, and chest X-rays were compared 1 year after starting the mix. 

There were 45 patients in the study, ranging in age from 12 months to 18.7 years (median 3.7 years). Twenty patients (44%) had a thin IDDSI-categorized mix, whereas 25 patients (56%) received a larger blend. In addition to the mix, patients were given 320 mL of water each day (range 0–1000 mL). Patients who received 20% thin liquids were less likely to have chest X-rays during follow-up than those who received higher percentages of thin liquids (10% in the minimal thin group versus 48% in the greater thin group, P=0.03). After correcting for underlying pulmonary illness, aspiration, feed delivery mode (bolus or continuous feeds), fundoplication status, and oral intake status, this link remained significant in multivariable logistic regression.

The research showed that patients on blenderized tube feeds received significantly varying volumes of additional thin liquids, such as water. While the water was generally added to tube feeds for hydration, it could alter feed viscosity and clinical results such as chest X-ray performance.