The Association Between Intranasal Steroids and Length of Stay in Children With Orbital Infections

Little is known about the use of intranasal agents in the management of orbital infections in children. This study aims to describe intranasal corticosteroid use in children hospitalized with orbital infections and to determine whether an association exists between intranasal corticosteroids and length of hospital stay.

A multicenter retrospective cohort study was conducted of children aged 2 months to 18 years with orbital infections, periorbital and orbital cellulitis, admitted to participating hospitals between 2009 and 2018. Baseline characteristics and intranasal corticosteroid use were described. The association between intranasal corticosteroids and length of stay was derived using a multivariable median regression model.

Of the 1570 children (935 [59.6%] male, median age 5.4 [IQR 2.4, 9.9] years) admitted for orbital infections, 693 (44.1%) received intranasal corticosteroids during their hospital admission. Median length of stay was 82.6 hours (IQR 48.3, 135.0). Of those who received intranasal corticosteroids, most received mometasone (n = 497, 71.7%). In the adjusted analyses, children who received intranasal corticosteroids had longer hospital stay by 14.9 hours (95% CI 8.4-21.4) as compared with those without intranasal corticosteroids. Findings were similar when the analysis was restricted to children with a diagnosis of orbital cellulitis.

Intranasal corticosteroid use in hospitalized children with periorbital and orbital cellulitis was associated with a small increase in length of stay, although immortal time bias or confounding by indications may be the primary driver of this given our study design. Further investigation is needed to better determine the effectiveness of intranasal corticosteroid use in children with orbital infections.