Variation in Inhaled Medication Use for Infants With Congenital Heart Disease and Bronchiolitis.

Area of Science:

• Pediatric Pulmonology
• Pediatric Cardiology
• Health Services Research

Background:

• Current viral bronchiolitis guidelines do not include infants with congenital heart disease (CHD).
• Therapeutic variations and their impact on clinical outcomes in this population are not well understood.
• This study addresses the knowledge gap regarding common therapeutic use in infants with CHD and bronchiolitis.

Purpose of the Study:

• To evaluate variations in beta-2 agonist and hypertonic saline use across hospitals for infants with CHD hospitalized with bronchiolitis.
• To determine hospital-level associations between the use of these medications and clinical outcomes.
• To inform evidence-based treatment strategies for bronchiolitis in infants with CHD.

Main Methods:

• Multicenter retrospective cohort study using administrative data (2015-2019).
• Included infants (≤12 months) hospitalized for bronchiolitis with a secondary diagnosis of CHD.
• Analyzed hospital-level medication use (beta-2 agonists, hypertonic saline) and associations with length of stay, readmission, mechanical ventilation, and ICU utilization.

Main Results:

• Identified 6846 hospitalizations for bronchiolitis in infants with CHD.
• Significant variation in beta-2 agonist (3.6%-57.4%) and hypertonic saline (0.0%-65.8%) use across hospitals.
• No association found between the proportion of days with medication use and patient outcomes (length of stay, readmission, ventilation, ICU use).

Conclusions:

• Hospital-level use of beta-2 agonists and hypertonic saline in infants with CHD hospitalized for bronchiolitis shows wide variation.
• Current therapeutic practices for these medications in this population are not linked to improved clinical outcomes.
• Further research is needed to establish optimal treatment guidelines for bronchiolitis in infants with CHD.