Bronchiolite et prise alimentaire des dernières 24 h : un outil de dépistage de l’hypoxie

Abstract

BackgroundHypoxia associated with bronchiolitis is not always easy to assess on clinical grounds alone. The aim of this study was to determine the value of food intake during the previous 24h (bottle and spoon feeding), as a percentage of usual intake (24h FI), as a marker of hypoxia, and to compare its diagnostic value with that of usual clinical signs. MethodsIn this observational, prospective, multicenter study, 18 community pediatricians, enrolled 171 infants, aged from 0 to 6months, with bronchiolitis (rhinorrhea+dyspnea+cough+expiratory sounds). Infants with risk factors (history of prematurity, chronic heart or lung disorders), breast-fed infants, and infants having previously been treated for bronchial disorders were excluded. The 24h FI, subcostal, intercostal, supracostal retractions, nasal flaring, respiratory rate, pauses, cyanosis, rectal temperature and respiratory syncytial virus test results were noted. The highest stable value of transcutaneous oxygen saturation (SpO2) was recorded. Hypoxia was noted if SpO2 was below 95% and verified. Results24h FI greater or equal to 50% was associated with a 96% likelihood of SpO2 greater or equal to 95% [95% CI, 91–99%]. In univariate analysis, 24h FI less than 50% had the highest odds ratio (13.8) for SpO2 less than 95%, compared to other 24h FI values and other clinical signs, as well as providing one of the best compromises between specificity (90%) and sensitivity (60%) for identifying infants with hypoxia. In multivariate analysis with adjustment for age, SpO2 less than 95% was related to the presence of intercostal retractions (OR=9.1 [95% CI, 2.4–33.8%]) and 24h FI less than 50% (OR=10.9 [95% CI, 3.0–39.1%]). Hospitalization (17 infants) was strongly related to younger age, 24h FI and intercostal retractions. ConclusionIn practice, the measure of 24h FI may be useful in identifying hypoxia and deserves further study.