General Pediatric Division, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland.
Pediatric Emergency Division, Department of Pediatrics, Gynecology and Obstetrics, University Hospitals of Geneva, Geneva, Switzerland.
JAMA Netw Open. 2020 Dec 1;3(12):e2030905. doi: 10.1001/jamanetworkopen.2020.30905.
Little is known about the natural course of oxygen desaturation in acute bronchiolitis. Information on risk factors associated with desaturation as well as the time to desaturation in infants with bronchiolitis could help physicians better treat these infants before deciding whether to hospitalize them.
To prospectively determine the frequency of desaturation in infants with bronchiolitis, along with the time to desaturation and risk factors associated with desaturation, and to compare infants who were hospitalized with those discharged home and evaluate risk factors for rehospitalization.
DESIGN, SETTING, AND PARTICIPANTS: This cohort study was conducted during the 2017 to 2018 and 2018 to 2019 respiratory syncytial virus seasons in a tertiary care pediatric emergency department in Switzerland. Included individuals were 239 otherwise-healthy infants aged younger than 1 year, diagnosed with acute bronchiolitis and oxygen saturation of 90% or more on arrival. Data were analyzed from July 2019 to October 2020.
After receiving triage care, study participants admitted to the emergency department were equipped with a pulse oximeter to continuously record oxygen saturation (Spo2 levels), regardless of subsequent hospitalization or discharge home.
The primary outcome was desaturation (ie, Spo2 < 90%) during the first 36 hours.
Of 239 infants enrolled, with a median (interquartile range [IQR]) age of 3.9 (1.5-6.5) months, 116 (48.5%) were boys and desaturation occurred in 165 infants (69.0%). Median (IQR) time to desaturation was 3.6 (1.8-9.4) hours. The rate of desaturation was similar between infants hospitalized and those discharged home (137 of 200 infants [68.5%] vs 28 of 39 infants [71.8%]; difference, -3.3%; 95% CI, -18.8% to 12.2%; P = .85). A more severe initial clinical presentation with moderate or severe retractions was the only independent risk factor associated with desaturation (odds ratio, 2.73; 95% CI, 1.49 to 5.02; P = .001). Of 39 infants discharged home, 22 infants (56.4%) experienced major desaturations. However, infants with desaturations, including those with major desaturations, had rates of rehospitalization similar to those of infants without desaturations (8 of 28 infants [28.5%] vs 3 of 11 infants [27.3%]; difference, 1.2%; 95% CI, -29.9% to 32.5; P > .99).
These findings suggest that rates of desaturation in infants with acute bronchiolitis were high and similar between infants who were hospitalized and those discharged home. A more severe initial clinical presentation was the only risk factor associated with desaturation. However, for infants discharged home, desaturation was not a risk factor associated with rehospitalization.
急性细支气管炎患者的血氧饱和度降低的自然病程知之甚少。有关与血氧饱和度降低相关的危险因素以及细支气管炎患儿发生血氧饱和度降低的时间的信息，可以帮助医生在决定是否住院治疗这些患儿之前更好地治疗他们。
前瞻性确定患有细支气管炎的婴儿发生血氧饱和度降低的频率，以及发生血氧饱和度降低的时间和与血氧饱和度降低相关的危险因素，并比较住院和出院回家的婴儿，并评估再次住院的危险因素。
设计、地点和参与者：这是一项队列研究，于 2017 年至 2018 年和 2018 年至 2019 年在瑞士一家三级儿科急诊室进行，纳入了 239 名年龄在 1 岁以下、被诊断为急性细支气管炎且入院时血氧饱和度为 90%或以上的健康婴儿。数据分析于 2019 年 7 月至 2020 年 10 月进行。
在接受分诊护理后，被送入急诊室的研究参与者被配备脉搏血氧仪，以连续记录血氧饱和度（Spo2 水平），无论随后是否住院或出院回家。
主要结局是在最初的 36 小时内发生血氧饱和度降低（即 Spo2<90%）。
在纳入的 239 名婴儿中，中位（四分位距[IQR]）年龄为 3.9（1.5-6.5）个月，116 名（48.5%）为男孩，165 名（69.0%）发生血氧饱和度降低。中位（IQR）发生血氧饱和度降低的时间为 3.6（1.8-9.4）小时。住院和出院回家的婴儿发生血氧饱和度降低的比例相似（200 名婴儿中的 137 名[68.5%]与 39 名婴儿中的 28 名[71.8%]；差异，-3.3%；95%CI，-18.8%至 12.2%；P=0.85）。初始临床症状更严重，存在中度或重度肋间隙凹陷，是唯一与血氧饱和度降低相关的独立危险因素（比值比，2.73；95%CI，1.49 至 5.02；P=0.001）。在 39 名出院回家的婴儿中，22 名（56.4%）经历了严重的血氧饱和度降低。然而，发生血氧饱和度降低的婴儿，包括发生严重血氧饱和度降低的婴儿，其再住院率与未发生血氧饱和度降低的婴儿相似（28 名婴儿中的 8 名[28.5%]与 11 名婴儿中的 3 名[27.3%]；差异，1.2%；95%CI，-29.9%至 32.5%；P>0.99）。
这些发现表明，急性细支气管炎患儿的血氧饱和度降低率较高，且住院和出院回家的患儿之间无差异。初始临床症状更严重是唯一与血氧饱和度降低相关的危险因素。然而，对于出院回家的婴儿，血氧饱和度降低不是再住院的危险因素。
