Investigators from France coordinated efforts to study whether food intake in the preceding 24 hours could serve as an indicator of hypoxia in infants with bronchiolitis. Infants from birth to 6 months old with symptoms of rhinorrhea, cough, dyspnea, and expiratory sounds were recruited from 18 community pediatrics offices in the Paris area during the winter months of 2006 to 2009. Because of the difficulty in assessing intake, infants who were breastfed were excluded. Food intake during the previous 24 hours (24h FI) was calculated as the sum of bottle and spoon feeding and expressed as a percentage of usual 24-hour intake. Infants were examined for signs of respiratory distress (nasal flaring, retractions, respiratory rate, cyanosis, and observed or parental reports of respiratory pauses). Only after these data had been recorded was transcutaneous pulse oximetry (SpO2) measured. The highest stable value of SpO2 was recorded. The main outcome of the study was the association between the 24h FI and other clinical signs or respiratory distress, as predictors of a SpO2 <95% in study infants.
During the study period, 171 infants with a mean age of 1.6±3.7 months were recruited. Assessment occurred between the 1st and 6th day (average 2 days) after the onset of chest sounds as reported by the parents. The 24h FI was <50% in 14% of infants, 50% to 70% in 26% of infants, and >70% in 60% of infants. Nasal flaring was seen in 2% of study infants, suprasternal retractions in 15%, intercostal retractions in 25%, subcostal retractions in 30%, respiratory rate ≥50/min in 43%, respiratory rate ≥60/min in 23%, and cyanosis was observed in 5 infants.
SpO2 was <95% in 9% of study infants and <90% in 2. The average SpO2 in infants whose 24h FI was ≤50% was 95.5% versus 98.1% in infants whose 24h FI was ≥50% of their usual intake (P < .001). If the 24h FI was ≥50% of the usual amount, the likelihood that oxygen saturation would be >95% was 96%. The sensitivity of 24h FI as a predictor of SpO2 <95% was 60% and the specificity was 90%. The odds ratio (OR) of having a SpO2 <95% when the 24 FI was <50% was 13.8, a higher OR than any of the other clinical signs evaluated.
The authors conclude that measurement of 24h FI may be useful for identifying hypoxia in infants with bronchiolitis.
Dr Webber has disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device.
Bronchiolitis causes a significant disease burden in pediatric populations worldwide. Diagnosis...