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Original Research

Program: Section on Critical Care

P2A232: Trends in non-covid-19 Respiratory Diagnoses in Infants from 2019-2020

Saturday, October 21, 2023
11:15 AM – 12:15 PM US EDT
Location: Walter E. Washington Convention Center, Exhibit Hall A
Poster Presentation
Background: Acute lower respiratory tract infections (ALRTI), frequently presenting as bronchiolitis caused by RSV, are a common cause of hospitalization and death in children. Younger ages are the most at-risk, experiencing higher rates of hospitalization and mortality from bronchiolitis.

The COVID-19 pandemic resulted in changes to viral patterns and severity, pediatric hospitalizations, and pediatric intensive care unit (PICU) admissions. The aim of this study was to compare infants hospitalized with non-COVID-19 respiratory diagnoses in 2019 and 2020. Outcomes during these two years include frequency of hospitalizations, diagnoses, mortality, hospital length of stay (LOS), and cost.

Methods: Retrospective national data was extracted from MarketScan database. Infants age < 1 year hospitalized with a variety of non-COVID-19 respiratory diagnoses based on ICD-10 codes from 2019 and 2020 were analyzed. These codes include viral and bacterial illness, structural airway diagnoses, chronic respiratory conditions, and dependence on respiratory support. Statistical analysis included descriptive statistics for categorical and continuous data, Wilcoxon rank sum test for nonparametric data, logistic regression for death outcomes, and multivariable modeling with transformations for LOS and cost outcomes.

Results: A total of 54,805 infant admissions coded for non-COVID-19 respiratory conditions were included, with admission falling from 37,332 in 2019 to 17,473 in 2020. Of these, 5,578 were readmissions. There was a significant difference from 2019-2020 regarding admission type (p < 0.0001) as well as discharge destination (p < 0.0001) (Table 1).

Significant differences were observed in ICD-10 code diagnoses except those for dependence on respiratory support (Table 2). Overall death rate decreased from 7.2% in 2019 to 2.91% in 2020. Mortality was significantly higher in 2019 compared to 2020 for children diagnosed with RSV (p < 0.0001) and other respiratory illnesses (p < 0.0001).

There was a significant difference in LOS, increasing nearly 1 full day in 2020 (p < 0.0001). Cost was also significantly different, with 2020 resulting in a cost of nearly $8,500 USD more (p < 0.0001).

Conclusion: Admissions and death rates for non-COVID-19 respiratory diagnoses in infants aged < 1 year significantly decreased in 2020 compared to 2019. LOS and cost increased in 2020. These findings may reflect a variation in healthcare utilization, shifting viral epidemiology, and/or transmission of respiratory viruses due to the pandemic. Ongoing data collection and dissemination is warranted to fully understand the impact of COVID-19 on viral transmission and severity patterns and will aid in the creation of public health recommendations aimed at reducing infant mortality and decreasing healthcare burden.