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Infants with bronchiolitis maintain similar home desaturation rates after hospital discharge

Pediatric patients with bronchiolitis who were admitted to the hospital with oxygen desaturations continued to experience desaturations after discharge, according to recent research.

“The majority of infants with mild bronchiolitis experienced recurrent or sustained desaturations after discharge home,” Tania Principi, MD, FRCPC, of the Research Institute at The Hospital for Sick Children in Toronto, Canada, and colleagues wrote. “Children with and without desaturations had comparable rates of return for care, with no difference in unscheduled return medical visits and delayed hospitalizations.”

Principi and colleagues evaluated 118 infants (mean age, 4.5 months; 58% boys) admitted to a hospital with an unscheduled visit due to bronchiolitis and discharged within 72 hours both with and without oxygen desaturations, according to the abstract. The mean monitoring period was 19 hours and 57 minutes (SD, 10 hours and 37 minutes).

Fifty percent of the infants had at least three desaturations, 10% (n = 12) had a desaturation event for longer than 10% of the monitored time and 43% (n = 51) had a desaturation lasting 3 minutes or longer, according to the abstract. The researchers found 64% (n = 75) had a desaturation event during the monitoring period lasting a median continuous duration of 3 minutes and 22 seconds (interquartile range = 1 minute, 54 seconds to 8 minutes, 50 seconds). Of those patients, 75% (n = 59) had a desaturation to 80% or less for 1 minute, 29 seconds or more and 39% had a desaturation to 70% or less for 1 minute or longer.

Eighteen of 75 patients (24%) had an unscheduled visit for bronchiolitis in the desaturation group vs. 11 of 43 patients (26%) in the group without desaturation (difference, –1.6%; 95% CI, −0.15 to ∞), according to the abstract. There was a hospitalization within 72 hours for 1 of 75 (1%) patients in the desaturation group and 2 of 43 (5%) in the group without desaturation (difference, −1.6%; 95% CI, −0.15 to ∞). Principi and colleagues noted that 77% (n = 48) of patients experienced desaturations during their sleep or while feeding.

“Health care professionals and parents are obviously frustrated in caring for patients with bronchiolitis. The sheer volume strains the system, and there are no proven therapies, no helpful predictive models, and no easy objective measures of severity. The evidence points to a clinical evaluation that incorporates oxygen saturation into the decision-making but does not absolutely determine disposition,” Lalit Bajaj, MD, MPH, of the department of pediatrics at University of Colorado School of Medicine and Joseph J. Zorc, MD, MSCE, of the department of pediatrics at The Children’s Hospital of Philadelphia, wrote in an accompanying editorial. “The time has come to stop focusing on the numbers on Pandora’s box and to develop strategies to thoughtfully use the data it provides us in the overall clinical care of the patient.” – by Jeff Craven

Disclosure: Principi, the other researchers and Bajaj and Zorc report no relevant financial disclosures.