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
