Oxygen in Acute Bronchiolitis

Bronchiolitis is the most common cause of hospital admission in children under the age of 1 year in developed nations. Admissions for bronchiolitis sharply increased in the late 1980s and 1990s, and it is widely accepted that much of that increase was due to use of noninvasive assessment of oxygen saturation (SpO2) via pulse oximetry. This was combined with the creation of SpO2 cutoffs that would require hospitalization for supplemental oxygen. Pulse oximetry often influences the decision to admit and can lead to prolonged hospitalization for supplemental oxygen, often after work of breathing has resolved. In this article, we will review the data describing how oxygen saturation influences the decision to admit and length of hospitalization. We will then review the evidence supporting the use of supplemental oxygen in the home setting to avoid hospitalization and recent data on the incidence of hypoxia in these infants and its relationship to short term outcomes. We will conclude with a comment on further research and quality improvement work that is needed in this area.