Open Access Research article

Food intake during the previous 24 h as a percentage of usual intake: a marker of hypoxia in infants with bronchiolitis: an observational, prospective, multicenter study

François Corrard1*, France de La Rocque1, Elvira Martin1, Claudie Wollner1, Annie Elbez1, Marc Koskas12, Alain Wollner1, Michel Boucherat1 and Robert Cohen123

Author Affiliations

1 ACTIV (Association Clinique et Thérapeutique Infantile du Val de marne), 27 rue d’Inkermann, 94100, Saint Maur des fossés, France

2 Physiology Lung Function Department Armand-Trousseau Hospital, Paris, France

3 Department of Microbiology, CHI Créteil, 40 avenue de Verdun, Créteil, France

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BMC Pediatrics 2013, 13:6  doi:10.1186/1471-2431-13-6

Published: 11 January 2013

Abstract

Background

Hypoxia 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 24 hours (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.

Methods

In this observational, prospective, multicenter study, 18 community pediatricians, enrolled 171 infants, aged from 0 to 6 months, 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.

Results

24h FI ≥ 50% was associated with a 96% likelihood of SpO2 ≥ 95% [95% CI, 91–99]. In univariate analysis, 24h FI < 50% had the highest odds ratio (13.8) for SpO2 < 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 < 95% was related to the presence of intercostal retractions (OR = 9.1 [95% CI, 2.4-33.8%]) and 24h FI < 50% (OR = 10.9 [95% CI, 3.0-39.1%]). Hospitalization (17 infants) was strongly related to younger age, 24h FI and intercostal retractions.

Conclusion

In practice, the measure of 24 h FI may be useful in identifying hypoxia and deserves further study.

Keywords:
Bronchiolitis; Hypoxia; Feeding; Infant; Out-patient; Intercostal retraction; Subcostal retraction; Supracostal retractions; Respiratory syncytial virus