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Risk Factors for Respiratory Decompensation Among Healthy Infants With Bronchiolitis.
Nina M Dadlez1,2, Nora Esteban-Cruciani3,4, Asama Khan2
1Division of Pediatric Hospital Medicine, Department of Pediatrics, The Children's Hospital at Montefiore, New York, New York.
Hospital Pediatrics
|August 24, 2017
Summary
Younger infants, Black race, low oxygen levels, and visible breathing effort predict respiratory decompensation in bronchiolitis. These factors help identify infants needing closer monitoring and support.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Critical Care
Background:
- Bronchiolitis is common in infants, often requiring only supportive care.
- However, a subset of patients decompensate, necessitating ventilatory support.
- Predicting decompensation is crucial for appropriate resource allocation and monitoring.
Purpose of the Study:
- To identify predictors of respiratory decompensation in hospitalized infants with bronchiolitis.
- To inform expectant monitoring strategies for high-risk infants.
Main Methods:
- A retrospective review of 1217 infants (≤24 months) with bronchiolitis.
- Exclusion of infants with pneumonia or comorbidities.
- Multivariable logistic regression to identify independent predictors of respiratory decompensation, defined as need for advanced respiratory support.
Main Results:
- Younger age (≤6 months), Black race, emergency department hypoxemia, and retractions/accessory muscle use were significant predictors.
- Infants aged ≤3 months had an odds ratio of 3.25 for decompensation.
- Children with none of the four identified predictors had a low risk (3%) of decompensation.
Conclusions:
- Early identification of respiratory decompensation in bronchiolitis is vital.
- Key predictors include young age, Black race, hypoxemia, and signs of increased work of breathing.
- These factors can guide clinical decisions regarding monitoring intensity and respiratory support.
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