Oxygen desaturation in acute bronchiolitis frequent in infants

In a recent study, oxygen desaturation rates in infants with acute bronchiolitis were high and occurred in most infants, with similar rates in those hospitalized and those discharged home, researchers reported in JAMA Network Open.

“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. 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,” Fabiola Stollar, MD, PhD, deputy head in the general pediatric division in the department of pediatrics, gynecology and obstetrics at the University Hospitals of Geneva, told Healio. “Our study showed that the evaluation of clinical status is more important than SPO₂ values alone when deciding on the need for hospitalization.”

Researchers conducted the cohort study during the 2017-2018 and 2018-2019 respiratory syncytial virus seasons in a pediatric ED in Switzerland. The study included 239 infants (median age, 3.9 months; 48.5% boys) diagnosed with acute bronchiolitis and with an oxygen saturation below 90%. The primary outcome was desaturation during the first 36 hours.

Desaturation occurred in 69% of infants, with a median time to desaturation of 3.6 hours.

Fabiola Stollar, MD, PhD

Rates of desaturation were similar at 68.5% in infants hospitalized with acute bronchiolitis compared with 71.8% in those discharged home (difference, –3.3 percentage points; 95% CI, –18.8 to 12.2; P = .85).

Fifty-six percent of infants discharged home experienced major desaturation. However, the researchers reported similar rehospitalization rates: 28.5% in infants with desaturations, including major desaturations, compared with 27.3% in infants without desaturations (difference, 1.2 percentage points; 95% CI, –29.9 to 32.5; P > .99).

The only independent risk factor associated with desaturation was a more severe initial clinical presentation with moderate or severe retractions (OR = 2.73; 95% CI, 1.49-5.02; P = .001), according to the researchers.

“Further studies are necessary to better evaluate the validity of the threshold of an SPO₂ of 90% for hospitalization and the consequences of desaturation at home,” Stollar said. “Additionally, there is a need to better define how pulse oximetry can be integrated into bronchiolitis management algorithms.”

Editor’s note: This article was updated on Feb. 10, 2021, to include quotes from the researcher and additional information.

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Fabiola Stollar, MD, PhD, can be reached at fabiola.stollar@hcuge.ch.