In a retrospective case-control study of 542 otherwise healthy full-term infants aged <1 year admitted for bronchiolitis with positive RSV tests, tachypnea (rate >80) and hypoxia (SaO2<85%) were predictive of the need for pediatric ICU–level care (the specificity for predicting deterioration was 97%, but the sensitivity was only 30%).4 The authors concluded that the use of any specific variable for a single patient is limited because of its low sensitivity for detecting the risk of an adverse outcome.
Several studies have attempted to define admission criteria or decision-making tools for admission of these infants, but all used the clinical opinion of the attending pediatrician as their gold standard and many excluded infants discharged within 24 hours, thus limiting their applicability to an outpatient population.4,7-10 Common criteria in these studies were an SaO2 ≤93% or history of complicating illness such as congenital heart disease, prematurity, or lung disease, plus the clinical impression of the attending physician.
TABLE
Risk factors for deterioration in infants with bronchiolitis
| Initial presentation |
|
| Age | Age <12 months |
| The lower the age, the higher the risk | |
| Comorbidities | Bronchopulmonary dysplasia |
| Cystic fibrosis | |
| Congenital heart disease | |
| Prematurity | Gestational age at birth <36 weeks |
| Other | Lower annual family income4 |
Recommendations from others
The American Academy of Pediatrics does not have a guideline addressing this issue. The only guideline listed at the National Guidelines Clearinghouse was a 2005 Cincinnati Children’s Hospital Medical Center guideline for managing infants with bronchiolitis; it is grounded in assuring good patient oxygenation and hydration.11 This guideline does not give specific criteria for admission but leaves this decision to the judgment of the physician. It also notes that the benefits of hospitalization center on the ability to closely monitor clinical status (including airway maintenance and hydration) and educating parents. The guideline recommends starting supplemental oxygen when SaO2 is consistently less than 91% and weaning when higher than 94%.