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Nasogastric Hydration in Infants with Bronchiolitis Less Than 2 Months of Age
Ed Oakley1, Sonny Bata1, Sharmila Rengasamy1
1Department of Emergency Medicine, Royal Children's Hospital Victoria, Parkville, Victoria, Australia.
Insights
Nasogastric hydration is a safe and effective option for infants under two months with bronchiolitis, showing similar complication rates to intravenous hydration. This method is suitable for most young infants requiring non-oral hydration.
Area of Science:
- Pediatrics
- Neonatology
- Respiratory Medicine
Background:
- Bronchiolitis is a common respiratory infection in infants.
- Hydration is crucial for managing infants with bronchiolitis, especially those under 2 months.
- Non-oral hydration methods include nasogastric and intravenous (IV) fluid hydration.
Purpose of the Study:
- To evaluate the feasibility of nasogastric hydration in infants younger than 2 months with bronchiolitis.
- To compare the adverse event profiles of nasogastric versus IV fluid hydration in this population.
- To assess the association of hydration method with intensive care unit admission and respiratory support.
Main Methods:
- A descriptive retrospective cohort study was conducted across three centers over three bronchiolitis seasons.
- Infants under 2 months with bronchiolitis requiring non-oral hydration were analyzed.
- Data collected included hydration type (nasogastric vs. IV), adverse events, ICU admission, and respiratory support.
Main Results:
- Of 491 infants, 211 (43%) received non-oral hydration (146 nasogastric, 65 IV).
- Adverse event rates were similar between nasogastric (27.4%) and IV (23.1%) hydration groups.
- IV fluid hydration was associated with higher rates of ICU admission and ventilation support compared to nasogastric hydration.
Conclusions:
- Nasogastric hydration is a viable option for the majority of young infants hospitalized with bronchiolitis.
- Nasogastric and IV fluid hydration demonstrate comparable complication rates.
- Nasogastric hydration may be associated with reduced need for intensive care and respiratory support.
Objectives:
To determine whether nasogastric hydration can be used in infants less than 2 months of age with bronchiolitis, and characterize the adverse events profile of these infants compared with infants given intravenous (IV) fluid hydration.
Study Design:
A descriptive retrospective cohort study of children with bronchiolitis under 2 months of age admitted for hydration at 3 centers over 3 bronchiolitis seasons was done. We determined type of hydration (nasogastric vs IV fluid hydration) and adverse events, intensive care unit admission, and respiratory support.
Results:
Of 491 infants under 2 months of age admitted with bronchiolitis, 211 (43%) received nonoral hydration: 146 (69%) via nasogastric hydration and 65 (31%) via IV fluid hydration. Adverse events occurred in 27.4% (nasogastric hydration) and 23.1% (IV fluid hydration), difference of 4.3%; 95%CI (-8.2 to 16.9), P = .51. The majority of adverse events were desaturations (21.9% nasogastric hydration vs 21.5% IV fluid hydration, difference 0.4%; [-11.7 to 12.4], P = .95). There were no pulmonary aspirations in either group. Apneas and bradycardias were similar in each group. IV fluid hydration use was positively associated with intensive care unit admission (38.5% IV fluid hydration vs 19.9% nasogastric hydration; difference 18.6%, [5.1-32.1], P = .004); and use of ventilation support (27.7% IV fluid hydration vs 15.1% nasogastric hydration; difference 12.6 [0.3-23], P = .03). Fewer infants changed from nasogastric hydration to IV fluid hydration than from IV fluid hydration to nasogastric hydration (12.3% vs 47.7%; difference -35.4% [-49 to -22], P < .001).
Conclusions:
Nasogastric hydration can be used in the majority of young infants admitted with bronchiolitis. Nasogastric hydration and IV fluid hydration had similar rates of complications.
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