Oxygen Saturation Poor Predictor of Return Visits For Infant Respiratory Infections

MedicalResearch.com Interview with:

Suzanne Schuh, MD, FRCP(C), ABPEM The Hospital for Sick Children affiliated with the University of Toronto

Dr. Suzanne Schuh

Suzanne Schuh, MD, FRCP(C), ABPEM
The Hospital for Sick Children affiliated with the
University of Toronto

Medical Research: What is the background for this study?

Dr. Schuh: Routine measurement of oxygen saturation in bronchiolitis is sometimes used as a proxy for illness severity, despite poor correlation between these parameters. This focus on oximetry may in part relate to lack of evidence on the natural history of desaturations in bronchiolitis which are often transient, and frequently not accompanied by increased respiratory distress. Desaturations occurring in infants with mild bronchiolitis in an ED often result in hospitalizations or prolonged hospital stay. They occur in healthy infants and may also occur in infants with mild bronchiolitis at home.

The main objective of this study of infants with acute bronchiolitis was to determine if there is a difference in the proportion of unscheduled medical visits within 72 hours of ED discharge in infants who desaturate during home oximetry monitoring versus those without desaturations. Our study shows that the majority of infants with mild bronchiolitis experience desaturations after discharge home.

Medical Research: What are the main findings?

Dr. Schuh: Children with and without desaturations had comparable rates of return for care, with no difference in unscheduled return medical visits and delayed hospitalizations. These findings suggest that pulse oximetry is not an effective tool to predict morbidity leading to escalated return for care.

Medical Research: What should clinicians and patients take away from your report?

Dr. Schuh: Oxygen saturation needs to be interpreted in the clinical context. Infants with bronchiolitis who can self- hydrate and have a satisfactory respiratory assessment with only a mild respiratory distress should be discharged home with careful follow up  and detailed instructions when to return for further care.

Medical Research: What recommendations do you have for future research as a result of this study?

Dr. Schuh: Having used oximetry routinely for the past 2-3 decades, we are finally on the path of retrofitting our clinical understanding of this technology.  This path is still in progress!

Citation:

Principi T, Coates AL, Parkin PC, Stephens D, DaSilva Z, Schuh S. Effect of Oxygen Desaturations on Subsequent Medical Visits in Infants Discharged From the Emergency Department With Bronchiolitis. JAMA Pediatr. Published online February 29, 2016. doi:10.1001/jamapediatrics.2016.0114.

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Suzanne Schuh, MD, FRCP(C), ABPEM (2016). Oxygen Saturation Poor Predictor of Return Visits For Infant Respiratory Infections MedicalResearch.com

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