NEW YORK (Reuters Health) – Oxygen desaturation is common in infants with acute bronchiolitis, especially in those who present with more severe initial illness, researchers from Switzerland report.
The natural course of oxygen desaturation in infants with acute bronchiolitis is unclear, Dr. Fabiola Stollar and colleagues with University Hospitals of Geneva note in their JAMA Network Open paper.
They assessed the frequency, timing, risk factors, and outcomes associated with oxygen desaturation in 239 otherwise healthy infants (mean age, 3.9 months) with acute bronchiolitis and initially normal oxygen saturation at presentation.
Oxygen desaturation (defined as at least one documented desaturation of <90% SpO2 lasting one minute or more) occurred in 165 infants (69%). The rate of desaturation was similar in babies who were admitted to the hospital (137 of 200, 68.5%) and their peers discharged home (28 of 39, 71.8%).
The median time to desaturation was 3.6 hours (range 1.8 to 9.4 hours).
The only independent risk factor for desaturation was a more severe initial clinical presentation with moderate or severe retractions (odds ratio, 2.73; 95% confidence interval: 1.49 to 5.02; P=0.001).
Of the 39 infants discharged home, more than half (n=22, 56.4%) had major oxygen desaturations (recurrent, prolonged or sustained desaturations).
However, infants with desaturations, including those with major desaturations, had no higher rates of rehospitalization than infants without desaturations (8 of 28 infants, 28.5% versus 3 of 11 infants, 27.3%). This finding is noteworthy, the researchers say, because if these infants had been in a monitored hospital setting at the time of desaturation, they would have undergone significant medical interventions.
“Currently, the decision on whether to hospitalize children with bronchiolitis is primarily influenced by desaturations measured using pulse oximetry, despite its questionable diagnostic value in defining illness severity,” Dr. Stollar and colleagues point out in their article.
“Many studies have shown that relying on oximetry as a major determinant in decisions to hospitalize infants with bronchiolitis was associated with significantly increased costs, patient harm, and hospitalization rates,” they add.
Dr. Stollar and colleagues say the decision to discharge home or to hospitalize should be based more on clinical presentation than on SpO2 value alone.
“Patients with deterioration in respiratory status should be hospitalized. However, as reported in a 2016 study and a 2015 study, infants with bronchiolitis who are deemed suitable for discharge home based on respiratory and hydration status should not undergo further oximetry,” they suggest.
“Missed desaturations are likely clinically unimportant in a satisfactory overall clinical status. Caregivers should be advised to return for a reevaluation if respiratory distress worsens or if the infant is consuming less than 50% of the required daily nourishment,” they add.
The study was supported by the Ernst et Lucie Schmidheiny Foundation and by the University of Geneva’s research and development projects fund. Dr. Stollar was unavailable for comment by press time.
SOURCE: http://bit.ly/2L2fvbO JAMA Network Open, online December 23, 2020.