PEDIATRICS Vol. 118 No. 3 September 2006, pp. 1319-1320 (doi:10.1542/peds.2006-1287)
LETTER TO THE EDITOR |
A Randomized Trial of Home Oxygen Therapy From the Emergency Department for Acute Bronchiolitis
Leon Joseph, MB ChBDepartment of Pediatrics,
Shaare Zedek Medical Center,
Jerusalem 91031, Israel
Shmuel Goldberg, MD
Elie Picard, MD
Shaare Zedek Medical Center,
Jerusalem 91031, Israel
Faculty of Health Sciences,
Department of Pediatric Pulmonology,
Ben Gurion University of the Negev,
Beer-Sheva 84105, Israel
To the Editor.—
We enjoyed reading "A Randomized Trial of Home Oxygen Therapy From the Emergency Department for Acute Bronchiolitis" by Bajaj et al.1 Their submission has important implications, bearing in mind the escalating admission rate for bronchiolitis over the last 25 years with its recurring peak-and-trough annual incidence rate.
However, we would like to point out that bronchiolitis is a progressive disease with a peak that comes after 48 to 72 hours from the onset of dyspnea.2 The stage of the disease at presentation was not taken into account by the authors; it is obvious that a child who has been ill for 4 days can be discharged with far greater safety than a child in his or her first day of illness. We are unsure whether the 8-hour observation period is adequate, because experience shows that the deterioration can come at any point within the first days of the disease.
Furthermore, no mention is made of apnea monitoring after discharge. It is well known that apnea is a part of respiratory syncytial virus disease3 and is a significant cause of morbidity and mortality. Indeed, 1 patient in this series (2.7% of those discharged from the hospital) had an episode suggestive of apnea. What training were the caregivers given? This patient was only referred to the hospital after a scheduled visit with the primary care provider. We feel that more care must be taken to educate these parents to bring a child with suspected apnea to medical attention immediately.
In addition, did the patients who were discharged from the hospital on oxygen have saturation monitoring at home? How did parents increase or decrease the flow rate? Is a 24-hourly visit with a pediatrician frequent enough for this kind of monitoring?
We applaud the efforts of Bajaj et al but feel that early discharge with oxygen therapy is not safe without taking into account the stage of disease that the patient is at, the risk of apnea at home, and the need for adequate follow-up and monitoring.
REFERENCES
- Bajaj L, Turner CG, Bothner J. A randomized trial of home oxygen therapy from the emergency department for acute bronchiolitis. Pediatrics. 2006; 117:633
–640
[Abstract/Free Full Text] - Goodman D. Inflammatory disorders of the small airways. In: Behrman RE, Kliegman R, Jenson HB, eds. Nelson Textbook of Pediatrics. Philadelphia, PA: Elsevier Health Sciences; 2004:1416
- Kneyber MC, Brandenburg AH, de Groot R, et al. Risk factors for respiratory syncytial virus associated apnoea. Eur J Pediatr. 1998;157 :331 –335[CrossRef][Web of Science][Medline]
PEDIATRICS (ISSN 1098-4275). ©2006 by the American Academy of Pediatrics
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  I M Balfour-Lynn, D J Field, P Gringras, B Hicks, E Jardine, R C Jones, A G Magee, R A Primhak, M P Samuels, N J Shaw, et al. BTS guidelines for home oxygen in children Thorax, August 1, 2009; 64(Suppl_2): ii1 - ii26. [Full Text] [PDF]
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