753 - Enteral Feeding in the Emergency Department Associated with Earlier Discharge for Children with Bronchiolitis
Monday, May 1, 2023
9:30 AM – 11:30 AM ET
Poster Number: 753 Publication Number: 753.415
Chaya Pitman Hunt, Central Michigan university, Canton, MI, United States; Peter Whittaker, Green Templeton College, University of Oxford, Oxford, England, United Kingdom; Amy DeLaroche, Children's Hospital of Michigan, Detroit, MI, United States; Jacqueline Leja, Children’s Hospital of Michigan, Detroit, MI, United States; Rajan Arora, Children's Hospital of Michigan, Detroit, MI, United States; Karima Lelak, Children's Hospital of Michigan, Detroit, MI, United States; Priya Spencer, Children's Hospital of Michigan, Detroit, MI, United States; Ciara Brennan, Central Michigan University College of Medicine, West Bloomfield, MI, United States; Joseph Bourdages, Central Michigan University College of Medicine, Lansing, MI, United States; Nirupama Kannikeswaran, Childrens Hospital ofMichigan, Detroit, MI, United States
Assistant Professor Central Michigan university Canton, Michigan, United States
Background: Acute bronchiolitis is a frequent cause of pediatric hospital admission. Although some guidelines recommend enteral feeding in patients with viral bronchiolitis, when feeding should begin is controversial. Concern remains regarding the risk of aspiration in children receiving high flow nasal cannula (HFNC) respiratory support. Our hospital implemented a policy change in 2021 to begin enteral feeding while on HFNC in the emergency department (ED). Objective: We aimed to determine if: (1) enteral feeding initiation in the ED was associated with shorter length of stay (LOS) and (2) feeding resulted in adverse outcomes.
Design/Methods: We assessed the effect of enteral feeding in 809 children diagnosed with bronchiolitis, less than two years of age, receiving HFNC respiratory support; we excluded patients admitted to intensive care units. Our retrospective analysis was conducted over 3 years: 18 months prior to the policy change (October 2018 to April 2019; n=451) and 18 months afterwards (October 2019 to April 2022; n=358). Because enteral feeding occurred in some patients before the policy change, but was not received by everyone after the change, we did not use a pre/post study design. Instead, to examine the effect of feeding on LOS, we constructed a logistic regression model to determine the odds ratio (OR) associated with LOS less than the median. In addition, we compared 7-day readmission rates for respiratory-related issues and aspiration-related events with and without feeding. Analysis was conducted using Stata.
Results: Most patients were male (60%) with median age of 7 months (IQR: 3, 12) and 21% were premature. The median LOS was 45.1 hours (IQR: 30.2, 64.4 hours). The model revealed enteral feeding had nearly two times higher odds for shorter hospital stay than mean LOS (OR 1.87, 95% confidence interval 1.11-3.18; adjusted for age, sex, negative viral testing results, initial HFNC rate, respiratory rate, oxygenation index, and policy period). The area under the receiver-operator-curve was 0.73, consistent with acceptable discrimination. We found no evidence for differences between observed and predicted values (P=0.33). Moreover, there were no differences in 7-day readmission rate (2.6% vs 1.8%; P=0.62) and no difference in aspiration-related events (0% vs 0%) between those who were and were not fed enterally.
Conclusion(s): Our study indicates initiation of enteral feeding in the ED is associated with shorter hospital stays, but not with adverse outcomes. This provides rationale for liberalizing feeding policies for patients managed with HFNC for acute bronchiolitis.
