Nasogastric Hydration Utilization in Bronchiolitis, an EMO Trial Observational Substudy.

Area of Science:

• Pediatric critical care medicine
• Neonatal and infant nutrition
• Respiratory infections

Background:

• Nasogastric (NG) fluid replacement is a viable alternative to intravenous (IV) hydration for pediatric patients with bronchiolitis.
• Existing research shows comparable outcomes for NG and IV hydration, but data on NG utilization across institutions is limited.

Purpose of the Study:

• To investigate the utilization of NG hydration in pediatric patients with bronchiolitis across multiple institutions.
• To examine the association between NG hydration and clinical factors, including respiratory support, intensive care unit (ICU) stay, and neurologic impairment (NI).

Main Methods:

• An observational, multicenter substudy of the Eliminating Monitor Overuse (EMO) Trial included 1707 pediatric inpatients aged 2-23 months with bronchiolitis.
• Data on NG and IV fluid replacement utilization rates were collected from 33 hospitals.
• Comparisons were made for maximum respiratory support, ICU stay, and NI between NG and IV hydration cohorts, with multivariable models analyzing factors associated with NG hydration and length of stay (LOS).

Main Results:

• Overall NG utilization was 7%, with significant institutional variation (0% to 70%) among patients receiving either NG or IV hydration.
• Patients requiring mechanical ventilation, ICU admission, or with NI were more likely to receive NG hydration.
• The length of stay (LOS) was 1.83 times longer for patients receiving NG hydration compared to IV hydration.

Conclusions:

• Nasogastric hydration is infrequently used in pediatric bronchiolitis, exhibiting substantial variation in utilization across hospitals.
• Critically ill children and those with neurologic impairment were more likely to receive NG hydration, suggesting its use in more severe cases.