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Overweight Infants Hospitalized for Bronchiolitis Associated With Severe Disease
Leann Madion1,2, Sarah Corey Bauer1,2, Amy Pan3
1Department of Pediatrics, Divisions of Hospital Medicine.
Insights
Overweight infants hospitalized with bronchiolitis experienced more severe illness, requiring increased respiratory support and higher intensive care unit admission rates. This highlights the impact of excess weight on pediatric respiratory health.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Public Health
Background:
- Pediatric respiratory infections like bronchiolitis pose significant health challenges.
- Overweight is a growing concern in childhood and may impact respiratory health.
Purpose of the Study:
- To investigate the association between overweight status and the severity of bronchiolitis in hospitalized infants.
- To determine if overweight infants exhibit worse respiratory outcomes compared to infants with standard or underweight status.
Main Methods:
- Retrospective cohort study of infants (30-365 days) hospitalized for bronchiolitis.
- Categorization of weight-for-length z-scores: overweight (>2), underweight (<-2), and standard weight (-2 to ≤2).
- Primary outcomes included respiratory support, ICU stay, and bronchiolitis severity score.
Main Results:
- Overweight infants (n=24) showed significantly higher rates of respiratory support (100%) and ICU admission (54.2%) compared to standard (n=335) and underweight (n=26) infants.
- Overweight infants had higher median bronchiolitis scores (8) and greater need for high-flow nasal cannula support (75%).
- Findings persisted after age adjustments, indicating a robust association.
Conclusions:
- Overweight status is linked to more severe bronchiolitis in hospitalized infants.
- Increased respiratory support, higher bronchiolitis scores, and greater ICU admission rates characterize severe cases in overweight infants.
- Limitations in acute care floor capabilities for high-flow nasal cannula may contribute to ICU admissions.
Objectives:
Overweight negatively affects pediatric respiratory function. In this study, we evaluate if overweight is associated with more severe bronchiolitis in hospitalized infants.
Methods:
This retrospective cohort study analyzed infants aged 30 to 365 days hospitalized for bronchiolitis from September 2019 to April 2020. Exclusion criteria included known risk factors for severe bronchiolitis, asthma treatment, or bacterial pneumonia. Weight-for-length z-score was categorized per the World Health Organization's growth assessments as overweight (z-score >2), underweight (z-score <-2), and standard weight (between -2 and ≤2). Primary outcomes included respiratory support, ICU stay, and local bronchiolitis score. Secondary outcomes included supplemental interventions.
Results:
After exclusion criteria, 385 of 644 infants were categorized as overweight (n = 24), standard (n = 335), or underweight (n = 26). There were differences in need for respiratory support (overweight, 100%; standard weight, 81.8%; underweight, 76.9%; P = .03), highest support of high-flow nasal cannula (overweight, 75%; standard weight, 48%; underweight, 42%; P = .03), admission to ICU (overweight, 54.2%; standard weight, 21.5%; underweight, 34.7%; P < .001), and median bronchiolitis score (overweight, 8 [interquartile range 5-10]; standard weight, 4 [3-7]; underweight, 4 [3-7]; P = .01). Findings remained significant after age adjustments. Additionally, overweight experienced higher frequency of certain treatments.
Conclusions:
This study suggests overweight is associated with more severe bronchiolitis in hospitalized infants supported by increased respiratory support level, bronchiolitis scores, and interventions. Higher need for ICU admission may be related to high-flow nasal cannula limitations on the acute care floor.
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