Hypomagnesemia as a Predictor of Noninvasive Respiratory Support in Children With Acute Obstructive Lower Airway Disease: A Retrospective PICU Cohort Study

Abstract

Aim

Acute obstructive lower airway disease (AOLAD) is a common cause of paediatric respiratory distress, yet early predictors of escalation beyond low-flow oxygen are limited. We aimed to identify admission factors associated with the need for noninvasive respiratory support (NRS; HFNC and/or nasal CPAP/BiPAP).

Methods

Retrospective observational study conducted in a tertiary paediatric intensive care unit in Türkiye (January 2020 and January 2025) including children aged 1 month to 5 years with AOLAD; pneumonia and asthma were excluded. Demographics, admission vital signs, laboratory values (including serum magnesium) and chest imaging findings were abstracted from electronic records. Univariable analyses reported crude associations, and multivariable logistic regression included prespecified clinically relevant covariates.

Results

Among 338 children (median age 11 months), 172 (50.9%) received NRS. In multivariable analysis, hypomagnesemia (OR 6.56; 95% CI 3.28–13.12), tachypnea (OR 2.40; 95% CI 1.29–4.46), acidosis (OR 2.01; 95% CI 1.15–3.54) and younger age (OR 0.98 per month; 95% CI 0.96–0.99) were independently associated with NRS.

Conclusion

Hypomagnesemia is a readily measurable marker associated with NRS requirement in paediatric AOLAD and may complement bedside assessment. Serum magnesium should be considered in the admission workup of patients with AOLAD.