581 - Nutritional status and respiratory syncytial virus bronchiolitis severity in infants

Publication Number: 2566.581

Erich Maul, University of Kentucky College of Medicine, Lexington, KY, United States; Brent T. Porter, Kentucky Children's Hospital, Lexington, KY, United States; Aric Schadler, University of Kentucky College of Medicine, Lexington, KY, United States; Brandon L. Schanbacher, Kentucky Children's Hospital, Lexington, KY, United States; Hong Huang, University of Kentucky, Lexington, KY, United States; John A. Bauer, Kentucky Children's Hospital, Lexington, KY, United States

Background: Respiratory Syncytial Virus bronchiolitis (RSVB) is one of the most common reasons for admission to children’s hospitals. Published literature shows increased risk and longer duration of intensive care admission with any form of malnutrition as well as longer overall hospital lengths of stay. The data describing how nutritional and anthropomorphic factors influence RSVB resource utilization and outcomes are varied, especially in young ages.

Objective: Our objective was to define the effect of under- and overnutrition on RSV bronchiolitis outcomes and resource utilization at our institution in children less than 2 years old.

Design/Methods: A retrospective cohort of infants < 24 months old admitted to a single children’s hospital with RSVB from July 2021 through August 2024 was identified from the electronic medical record. Weight for age Z-scores were computed and categorized into overnutrition, normal nutrition, mild, moderate, and severe malnutrition based on WHO standard Z-score definitions. We evaluated median length of stay, oxygen therapy, weight change, RSVB severity, and risk of transfer to intensive care. Nonparametric statistics with corrections for multiple comparisons as well as logistic regression were utilized. IRB approval was obtained.

Results: 518 patients with RSVB were admitted during the study period. 78.6% were under 12 months old with 58.1% under 6 months old. Based on bronchiolitis severity scores, 69.4% had mild disease, 17.1% had moderate disease while 13.5% had severe RSVB. Normal nutritional status was noted in 67.2% of the sample, with mild, moderate and severe malnutrition noted in 15.1%, 9.3%, and 4.7% respectively. Compared to normal nutritional status, severely malnourished children had longer median length of stay (80.2h vs. 47.7h, p< 0.05) and duration of oxygen therapy (64.4h vs 33.4h, p< 0.05). Overweight children lost more weight during their admission compared to all other categories. Odds ratio of intensive care transfer was 1.66 in moderate/severe malnutrition [95%CI 0.77, 3.73], and 1.11 for children aged < 6 months [95%CI 0.52, 2.36]. Although not statistically significant, 26.3% of children with severe malnutrition demonstrated severe RSVB compared to only 14.2% of children with normal nutrition and 6.3% of overweight children.

Conclusion(s): Children who are severely malnourished and hospitalized with RSVB have significantly longer lengths of stay and use of oxygen therapy. There are suggestions that malnutrition contributes to more severe presentations of RSVB as well as increased odds of intensive care transfer.