A new study questions the value of home pulse oximetry in infants with bronchiolitis well enough to be discharged home from the emergency department.

“The main conclusion is that the oximetry is not a very effective way for us to predict the return for care,” Dr. Suzanne Schuh of the Hospital for Sick Children, Toronto, Canada, said in a JAMA Pediatrics podcast.

For children with bronchiolitis “who in the opinion of the treating emergency physicians have satisfactory respiratory assessment to go home, further oximetry measurements should not be done,” she concluded.

Because bronchiolitis involves very young infants with respiratory distress it can at times be a “very scary disease to both the parents and the physicians alike. In addition to the usual clinical methods of judging the severity of bronchiolitis, there is pulse oximetry and the challenge is how to interpret the findings of oxygen saturation in the blood,” Dr. Schuh explained.

Since pulse oximetry started routinely being used in the mid-1980s, the hospitalization rate for bronchiolitis jumped about two and a half fold and experts feel this is largely due to the oxygen saturation measurements, she noted.

“Oxygen saturation is actually very dynamic. It goes up and down and it tends to go down when the infant is asleep or feeding. Sometimes the measurement goes below the comfort level of many physicians, especially when the infants are asleep, but these desaturations are frequently not accompanied by respiratory distress,” Dr. Schuh said.
The problem, she noted, is that these machines have certain preset alarms usually in the vicinity of 90 percent saturation, so when the infant falls asleep and the saturation drops below a predetermined cut-off, the alarm sounds, which often prompts action. “Supplemental oxygen is frequently begun and the child is admitted to hospital.”

As reported online in JAMA Pediatrics, the Toronto team studied the effect of oxygen desaturations on subsequent unscheduled medical visits in 118 infants clinically well enough to be discharged home from the ED. Each infant was sent home with a pulse oximeter.

During an average monitoring period of about 20 hours, desaturations were common: 75 infants (64 percent) had at least one oxygen desaturation to lower than 90 percent for at least one minute; 59 (50 percent) had at least three desaturations; 12 (10 percent) had desaturation for more than 10 percent of the monitored time; and 51 (43 percent) had desaturations lasting three or more minutes continuously.