Published online February 29, 2008
PEDIATRICS Vol. 121 No. 3 March 2008, pp. 470-475 (doi:10.1542/10.1542/peds.2007-1135)
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ARTICLE

Effect of Oxygen Supplementation on Length of Stay for Infants Hospitalized With Acute Viral Bronchiolitis

Stefan Unger, MBChB, BSc and Steve Cunningham, MBChB, MRCPCH, PhD

Department of Respiratory and Sleep Medicine, Royal Hospital for Sick Children, Edinburgh, United Kingdom

OBJECTIVE. The goal was to establish the final supportive therapy determinants of hospital length of stay for bronchiolitis.

METHODS. A retrospective case study of a randomly selected 25% of subjects <1 year of age who were hospitalized with bronchiolitis between April 1, 2003, and June 15, 2005 (n = 129), was performed. Records of 102 admissions to the general wards were reviewed (77 respiratory syncytial virus positive). Length of stay, pulse oxygen saturation profile, oxygen supplementation, feeding support, and nasal suction were determined. Infants admitted to the PICU (27 admissions) were excluded.

RESULTS. The majority of patients presented with feeding difficulties (82% at admission). Oxygen supplementation was not indicated initially for the majority of infants (22% with mean pulse oxygen saturation of 94%). However, oxygen treatment was required by 70% of infants by 6 hours, whereas the mean pulse oxygen saturation decreased by an average of only 2%. Feeding problems were resolved for 98% of infants by 96 hours, followed by oxygen supplementation resolving with an average lag of 66 hours. The mean pulse oxygen saturation at discharge was 95%. There was no significant correlation between pulse oxygen saturation at arrival at the emergency department and subsequent oxygen requirements or length of stay.

CONCLUSIONS. Oxygen supplementation is the prime determinant of the length of hospitalization for infants with bronchiolitis. Infants remaining in the hospital for oxygen supplementation once feeding difficulties had resolved did not experience deterioration to the extent of needing PICU support.

Key Words: bronchiolitis • oxygen inhalation therapy • hypoxia • oximetry • intubation • length of stay • clinical practice variations

Abbreviations: LOS—length of stay • RSV—respiratory syncytial virus • ED—emergency department • SpO2—pulse oxygen saturation • IQR—interquartile range

Accepted Aug 20, 2007.


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