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Frequency and Correlates of Pediatric High-Flow Nasal Cannula Use for Bronchiolitis, Asthma, and Pneumonia
Colin M Rogerson1, Aaron E Carroll2, Wanzhu Tu3
1Indiana University School of Medicine, Indianapolis, Indiana; and Regenstrief Institute Center for Biomedical Informatics, Indianapolis, Indiana. crogerso@iupui.edu.
Insights
Heated humidified high-flow nasal cannula (HFNC) use in children has surged by 400% for respiratory illnesses like asthma and pneumonia, not just bronchiolitis. Factors such as sex, race, age, and ethnicity significantly impact HFNC utilization in pediatric hospitalizations.
Area of Science:
- Pediatric Respiratory Medicine
- Health Services Research
Background:
- Heated humidified high-flow nasal cannula (HFNC) is a respiratory support device historically used in pediatrics for infants with bronchiolitis.
- No large-scale analysis has determined the current frequency or demographic distribution of HFNC use in children.
Purpose of the Study:
- To determine the frequency and correlates of HFNC use in children presenting to the hospital for asthma, bronchiolitis, or pneumonia.
Main Methods:
- Longitudinal observational study using electronic health record data from 2010-2019.
- Included children aged 0-18 with hospital encounters for bronchiolitis, asthma, or pneumonia.
- Generalized additive models and log-binomial regression analyzed HFNC use trends and risk factors.
Main Results:
- HFNC use increased 400% from 2010 to 2019 across bronchiolitis, asthma, and pneumonia.
- The 10-year prevalence of HFNC use was 2.54%, with encounters rising from 326 to 1,310 annually.
- Sex, race, age, ethnicity, and multiple diagnoses significantly influenced HFNC risk.
Conclusions:
- HFNC use in children with common respiratory diseases has substantially increased over the past decade.
- HFNC is now used beyond infants with bronchiolitis for asthma and pneumonia.
- Demographic and diagnostic factors significantly influence HFNC frequency in pediatric hospitalizations.
Background:
Heated humidified high-flow nasal cannula (HFNC) is a respiratory support device historically used in pediatrics for infants with bronchiolitis. No large-scale analysis has determined the current frequency or demographic distribution of HFNC use in children. The objective of this study was to determine the frequency and correlates of HFNC use in children presenting to the hospital for asthma, bronchiolitis, or pneumonia.
Methods:
This longitudinal observational study was based on electronic health record data from a large regional health information exchange, the Indiana Network for Patient Care (INPC). Subjects were age 0-18 y with recorded hospital encounters at an INPC hospital between 2010-2019 with International Classification of Diseases codes for bronchiolitis, asthma, or pneumonia. Annual proportions of HFNC use among all hospital encounters were assessed using generalized additive models. Log-binomial regression models were used to identify correlates of incident HFNC use and determine risk ratios of specific subjects receiving HFNC.
Results:
The study sample included 242,381 unique subjects with 412,712 hospital encounters between 2010-2019. The 10-y period prevalence of HFNC use was 2.54% (6,155/242,381) involving 7,974 encounters. Hospital encounters utilizing HFNC increased by 400%, from 326 in 2010 to 1,310 in 2019. This increase was evenly distributed across all 3 diagnostic categories (bronchiolitis, asthma, and pneumonia). Sex, race, age, and ethnicity all significantly influenced the risk of HFNC use. Over the 10-y period, the percentage of all hospital encounters using HFNC increased from 1.11% in 2010 to 3.15% in 2018. Subjects with multiple diagnoses had significantly higher risk of receiving HFNC.
Conclusions:
The use of HFNC in children presenting to the hospital with common respiratory diseases has increased substantially over the past decade and is no longer confined to treating infants with bronchiolitis. Demographic and diagnostic factors significantly influenced the frequency of HFNC use.
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