Pediatric Critical Care Medicine Fellow Duke University Hospital Durham, North Carolina, United States
Background: Breastfeeding is the recommended source of infant nutrition, so the AAP calls for pediatricians to be knowledgeable about its management, including understanding problems that may arise. Because RSV is a common infantile illness and prior studies have identified hospital admission for bronchiolitis as a high-risk event for breastfeeding disruption, this study aims to investigate long term breastfeeding outcomes in this population. Objective: The primary goal of this project is to assess whether hospitalization for RSV during early infancy is associated with decreased length of breastfeeding. It will secondarily examine factors such as illness severity, lactation support, patient demographics, and various medical aspects of the illness course that may impact breastfeeding outcomes. Design/Methods: This is a retrospective cohort study of breastfeeding infants under 6 months old admitted to Duke Children’s Hospital with RSV, viral gastroenteritis, urinary tract, and skin and soft tissue infections between July 2012 and 2022 . Data was collected via electronic health record, including information on demographics, nutrition, illness course, and lactation support. Follow-up nutrition information was collected from each follow up visit through infancy. Results: The study population was a racially and ethnically diverse group of 96 infants, in which 60 were admitted with RSV and 36 with other infectious illnesses. The RSV cohort had a mean age of 2.1 (sd 1.6) months and median length of stay of 4 (IQR 2-6) days, compared to 1.6 (sd 1.4) months and 2 (IQR 2-4) days in the Other Illness cohort. In the infants with RSV compared to Other Illness: 33/60 (55%) vs none required PICU admission, 30/60 (50%) vs 4/36 (11.1%) were made NPO, and 26/60 (43.3%) vs 15/36 (41.7%) received multiple lactation supportive measures. Of the 86 infants with six month follow up data available, 33/54 (61.1%) of infants with RSV were still breastfeeding compared to 23/32 (71.9%) of the others, with chi-square analysis revealing no significant difference between the two, X2(1, N = 86) = 1.02 (p = 0.31).
Conclusion(s): This study revealed no significant differences in age of admission or length of stay between the two groups, however trends toward ICU admission and NPO status were appreciated in the RSV group. The 10% lower six month breastfeeding rate in the RSV group was not statistically significant, though notably this study was not adequately powered to detect this difference. Further analysis, including a never hospitalized control group and future studies with larger sample size are needed to better elucidate this relationship.
