P0590 - Hospitalization For Iron Deficiency Anemia In Young Children: A Multicenter Analysis

Background:
Iron deficiency anemia (IDA) can be detrimental to growth and neurodevelopmental outcomes in young children. Approximately 3–7% of preschool children will experience IDA, typically due to dietary habits. IDA is primarily managed in the outpatient setting, though some children with severe anemia may require admission for evaluation or management. No prior studies exist looking at children with severe IDA admitted to US children’s hospitals.

Objectives:
The primary objective is to describe characteristics of children requiring inpatient admission for a primary diagnosis of IDA. We further aimed to describe the management of these patients and factors associated with readmission.

Methods:
Using the Pediatric Health Information system (PHIS) database, an administrative database collecting inpatient data from 52 US Children’s Hospitals, we identified children age 0-5 years admitted from 2004-2018 with a primary diagnosis of IDA. Information abstracted included demographics, laboratory studies, blood product transfusion, medication administration and hospital resource utilization. We compared the characteristics of patients who did or did not require ICU admission and patients who did or did not require readmission by chi-square test or t-test of means, respectively. Univariate logistic regression was used to identify factors associated with readmission.

Results:
A total of 4963 unique patients were identified who accounted for 5202 hospitalizations during the study period. The mean age at admission was 1.6 years with no gender difference. The population was predominantly white (52.2%) and 21.3% Hispanic. A trend towards an increasing number of admissions was noted in recent years (18% in 2004-2006 vs 23% in 2016-2018), as represented in the attatched figure. In terms of hospital resource utilization as denoted in the attatched table, the majority of the patients received blood transfusions (86.8%) and oral iron (59.1%), whereas only 5.1% of patients received intravenous iron. Overall, 13% of patients required ICU admission, which was more common in female patients and children of Black or Asian race. Readmission within 7 days was seen in 67 children (1.3%) and 180 children (3.6%) were readmitted with IDA at any time point. Blood transfusion and oral iron during the hospitalization were associated with decreased odds of readmission. Multiple admissions were more common in older children. Patients who were readmitted were significantly more likely to receive IV iron and less likely to receive a transfusion.

Conclusion:
The recent uptrend in admissions and substantial requirement of hospital resources including blood transfusion is concerning as IDA is preventable with the potential for detrimental long term outcomes. Further study is essential to understand the etiology of the increase in admissions and for prevention of severe IDA.