Association of NPO Status and Type of Nutritional Support on Weight and Length of Stay in Infants Hospitalized With Bronchiolitis

Abstract

Objectives: We investigated the association of nil per os (NPO) status and subsequent nutritional support with patient weight and length of stay (LOS) during admission for bronchiolitis in patients <2 years old. Methods: A retrospective chart review was performed of all patients <2 years old admitted to an academic pediatric hospital between November 2009 and June 2011 with a Current Procedural Terminology code of bronchiolitis. Data extracted from the medical record included respiratory rate, per os/NPO status, use of intravenous fluids, use of enteral tube feedings, weight, and LOS. Patients who did not have 2 weights recorded were excluded. The major outcome measures were weight change during admission and LOS. Results: The study included 149 patients. The mean ± SD patient age was 3.7 ± 3.8 months, with a median age of 2 months. The median length of stay was 4 days (interquartile range: 3–6). Overall, 16% of patients were made NPO, 75% received intravenous fluids, and 9% received enteral tube feedings. The mean weight loss for all patients was 38 (289) g during the hospitalization, which was not statistically significant. No significant association was found between weight loss and LOS, per os/NPO status, or use of intravenous fluids. However, NPO status was associated with a significant increase in LOS. Conclusions: The infants admitted for bronchiolitis did not demonstrate weight loss in this study; however, an association was seen between NPO status and prolonged LOS.

Nutrition and High-Flow Nasal Cannula Respiratory Support in Children With Bronchiolitis

“…22,23 Several other studies have investigated clinical outcomes and their relation to nutrition in children with bronchiolitis. 6,7,24 Weisgerber et al 7 retrospectively reviewed the nutrition data for infants with bronchiolitis admitted to a single center and found a significant correlation between diminished caloric intake early in hospitalization and prolonged hospital length of stay. Future studies could evaluate the incorporation of early feeding in a bronchiolitis care path in the PICU to reduce hospital length of stay and hospital costs.…”

“…3,4 There are limited published data regarding appropriate nutritional support in children hospitalized with bronchiolitis, including patients with severe dyspnea admitted to the PICU. [5][6][7][8][9] There are no published data regarding the safety of beginning enteral feeds in children on high-flow nasal cannula (HFNC), a respiratory support modality used with increasing frequency. [10][11][12][13][14] Children treated with HFNC do not consistently receive early enteral nutrition, probably because of concerns about loss of feeding coordination, aspiration risk, and impending respiratory failure, leading to invasive mechanical ventilation (MV).…”

Respiratory syncytial virus bronchiolitis among refugees and asylum seekers from war‐torn countries

“…Nevertheless, given that both disease severity and LOS in infant bronchiolitis are affected by abnormal weight, 17 lower weight percentiles alone might have played a role in the longer LOS of refugees. Halvorson et al demonstrated a correlation between nil per‐os feeding and prolonged LOS, 18 albeit without a clear relationship of causation.…”

Nutritional status, intake, and outcomes in critically ill children with bronchiolitis

“…To the best of our knowledge, this is the first study investigating the effects of nutrition on clinical outcomes in critically ill children with bronchiolitis. Although prior retrospective studies have shown an association between promptness of nutrition provision and improved outcomes in children with bronchiolitis, 9,33 they were not conducted specifically on those who were critically ill. Metabolic differences may exist, and our findings suggest that optimal nutritional practices in these children are not yet completely understood. In addition, other studies did not account for the patients’ possibly differing severities of illness; promptness of nutrition may have been an indicator of lower initial severity of bronchiolitis, which in turn leads to better clinical outcomes.…”