Centralized Telemetry Enables Continuous Monitoring to Predict Clinical Deterioration in Infants Hospitalized with Bronchiolitis

Abstract

Objective

Bronchiolitis is the leading cause of hospitalization in infants, and early detection of clinical deterioration remains a major challenge in pediatric wards. The objective is to analyze continuous longitudinal telemetry data (heart rate [HR] and oxygen saturation [SpO₂]) in infants hospitalized with bronchiolitis, and to evaluate whether this monitoring allows early prediction of the need for high-flow nasal cannula (HFNC) therapy or pediatric intensive care unit (PICU) admission.

Study Design

Retrospective, observational study in infants admitted for bronchiolitis (October 2021–January 2022). Clinical, epidemiological, and longitudinal data were collected using minute-by-minute HR and SpO₂ during the first 24 hours of admission using Vital Sync (Medtronic). A mixed model (restricted maximum likelihood; REML) was constructed to model the longitudinal HR and SpO₂ data.

Results

About 79 patients with 113,760 longitudinal HR and SpO₂ data were included. A total of 16.5% required HFNC, and 9% were admitted to PICU. A higher HR was observed in the first hours of admission in those patients who required PICU (163 ± 5 vs. 146 ± 4 bpm; p < 0.01) and in those who required HFNC (158  ± 6 vs. 144 ± 5 bpm; p < 0.01). In the mixed model (REML), we found differences in HR (p < 0.01) between groups (PICU yes/no and HFNC yes/no) and over time (p < 0.01). The mixed model allowed prediction of the mean HR of patients admitted to PICU (162 bpm) and those requiring HFNC (159 bpm).

Conclusion

Continuous monitoring of HR in infants hospitalized for bronchiolitis in pediatric wards may be a useful tool to help anticipate clinical deterioration.

Key Points

• Longitudinal continuous telemetry in infants with bronchiolitis may be a useful tool.

• Centralized telemetry monitoring may be promising in pediatric wards outside intensive care units.

• HR monitoring may be useful for the need for admission to the PICU.

Keywords

bronchiolitis - telemetry - continuous cardiorespiratory monitoring - heart rate

Publication History

Received: 01 August 2025

Accepted: 02 December 2025

Article published online:
18 December 2025

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