(334) Childhood Opportunity Index in Infants Requiring Noninvasive Respiratory Support for Bronchiolitis

Introduction: Bronchiolitis is the leading cause of infant PICU admission. Social determinants of health (SDoH) have been associated with worse outcomes in pediatric illness but have not been well-studied in critical bronchiolitis. We sought to examine the relationship between Child Opportunity Index (COI, a composite measure of neighborhood-level SDoH) and outcomes of infants requiring ICU-noninvasive respiratory support for bronchiolitis. We hypothesized that lower COI is associated with worse outcomes for critically ill infants with bronchiolitis, such as longer duration of ICU-level respiratory support and ICU length of stay.

Methods: This was a prospective, multicenter, observational review of infants ( < 1 year) who were admitted to 26 US PICUs from the BACON-2 Study for bronchiolitis and required noninvasive respiratory support between 09/2023 and 04/2024. Using residential ZIP codes, patients were stratified into one of the five COI quintiles (Very High (VH) to Very Low (VL)). To measure the association between COI and study outcomes (duration of NIV respiratory support, ICU and hospital length of stay (LOS)), the cohort was divided into ‘Lower COI’ (VL, Low, Moderate) and Higher COI (High and VH) groups. Data were analyzed using Chi-square or Wilcoxon rank-sum tests

Results: 173 infants [median age 4 (2,8) months; 34% female] were stratified by COI [VL 42 (24%); Low 40 (23%); Moderate 30 (17%); High 26 (15%); VH 34 (20%)]. Black race was more common in VL COI (48% vs ≤20% in other strata). VL (79%) and Low (70%) COI groups were more likely to have public insurance (≤20% in other strata). VL COI had the highest rates of comorbidities (43% overall; of these, prematurity was present in 21%, cardiac 17%, respiratory 7.1%). Lower COI was associated with longer hospital LOS [4.2 (3, 6) vs 3.6 (2.1, 4.9) days; p=0.03]; however there were no differences in duration of ICU-level respiratory support [42.4 (25, 78) vs 39.6 (23, 66) hours; p=0.30] or ICU LOS [2.6 (1.8, 4) vs 2.5 (1.7, 3.6) days; p=0.65].

Conclusions: Infants with critical bronchiolitis in lower COI strata had higher rates of comorbidities and longer hospital LOS. The increase in overall hospital resource utilization may be related to unmet social needs. Further research is needed to understand why these disparities exist.