Authors (including presenting author) :
Ng DYH Hau SF
Affiliation :
The Department of Paediatrics and Adolescent Medicine, Kwong Wah Hospital, Kowloon
Introduction :
Viral bronchiolitis is a common reason for hospital admission for infants aged under 24 months of age. Traditionally, oxygen therapy is prescribed to infants with bronchiolitis to maintain peripheral capillary oxygen saturation of 94% or higher. However, American Academy of Pediatrics recommends a permissive hypoxaemic target with an oxygen saturation of 90%, which is consistent with the WHO recommendations for targets in children with lower respiratory tract infections. A randomised, double-blinded study published in the Lancet in 2015 concludes the management of infants with bronchiolitis with an oxygen saturation target of 90% or higher is as safe and clinically effective as a target of 94% or higher.
Objectives :
We aimed to assess whether a use of target oxygen saturation of 94% or higher prolongs duration of hospital stay for infants admitted to hospital with viral bronchiolitis.
Methodology :
We retrospectively analysed records for all infants admitted to general paediatrics in-patient ward with a diagnosis of bronchiolitis aged 1-24months over a 3-months period. All patients' case summaries were reviewed. We record if each patient was given oxygen therapy during their hospital admission and their respective duration of hospital stay. For infants receiving oxygen therapy, we collected data on the lowest oxygen saturation before starting oxygen therapy, the mode of oxygen delivery, the amount or concentration of oxygen supplementation given and the target oxygen saturation. In addition, the modified-Clinical Asthma Score and the feeding status of the infant during his or her hospital stay were also recorded.
Result & Outcome :
There was 25 infants with bronchiolitis admitted to our general paediatric ward over a 3-month period, of which 4 were given supplementary oxygen. The mean duration of hospital stay for infants who received oxygen therapy is 5.25 days compare to 3.38 days for infants who did not receive oxygen therapy. The 4 infants who received oxygen therapy had an oxygen saturation of 88 to 91% before initiation of oxygen therapy. The prescribed target oxygen saturation were ≥92% or ≥94%. All infants who received oxygen therapy had a modified-Child Asthma Score (an objective measure of disease severity) of ≤2 during oxygen prescription. All infants had satisfactory oral feeding with no vomiting for at least a day before stopping oxygen supplementation. Conclusion: Supplementary oxygen therapy was the limiting factor preventing hospital discharge in all the infants who required oxygen therapy. The use of target oxygen saturation of ≥92 or ≥94% in the management of infants admitted to hospital with bronchiolitis is associated with a prolonged hospital stay. We recommend that the equally safe and effective target oxygen saturation of ≥90% be used instead, so we can reduce the length of patient stay for bronchiolitis patients in our general paediatric wards. This will relieve pressure and staff workload in particular during winter-surge periods, while maintaining internationally-recognised standard in the management of infants with viral bronchiolitis.
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