Nasogastric Hydration Utilization in Bronchiolitis, an EMO Trial Observational Substudy

BACKGROUND Nasogastric (NG) fluid replacement is an effective and nutritionally beneficial alternative to intravenous (IV) hydration for pediatric inpatients with bronchiolitis. Existing evidence demonstrates equipoise in the use of NG vs IV hydration; however, interinstitutional data on NG hydration utilization are lacking. OBJECTIVES To describe NG hydration in bronchiolitis across institutions and its association with clinical factors and outcomes. METHODS This observational multicenter substudy of the Eliminating Monitor Overuse (EMO) Trial collected data on fluid replacement for pediatric inpatients. Children aged 2 through 23 months with bronchiolitis between January and May 2023 were included. Those with extreme prematurity, apnea or cyanosis, or comorbid conditions that could impact pulse oximetry use were excluded. We measured NG and IV utilization rates over all encounters and then measured institution-specific rates in patients receiving either NG or IV hydration. Maximum respiratory support, intensive care unit (ICU) stay, and neurologic impairment (NI) were compared between NG and IV cohorts. Multivariable models examined factors associated with NG hydration and length of stay (LOS). RESULTS Our substudy included 1707 observations from 33 hospitals. Overall NG utilization was 7%, and IV use was 52%. Among patients who received either NG or IV hydration, institution-specific NG utilization ranged from 0% to 70%. Patients on mechanical ventilation, in the ICU, and with NI were more likely to receive NG hydration. LOS was 1.83-fold longer (95% CI, 1.62–2.06) for patients who received NG compared with IV hydration. CONCLUSIONS We found overall low use of NG hydration, with wide between-hospital variation. Children who experienced critical illness and NI were more likely to receive NG hydration.