title: 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.
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.
  
  
  CONCLUSIONS
  In practice, the measure of 24 h FI may be useful in identifying hypoxia and deserves further study.
authors: ACTIV (Association Clinique et Thérapeutique Infantile du Val de marne), Saint Maur des fossés, France. francois.corrard@free.fr
authors: François
authors: F
authors: Corrard
authors: France
authors: F
authors: de La Rocque
authors: Elvira
authors: E
authors: Martin
authors: Claudie
authors: C
authors: Wollner
authors: Annie
authors: A
authors: Elbez
authors: Marc
authors: M
authors: Koskas
authors: Alain
authors: A
authors: Wollner
authors: Michel
authors: M
authors: Boucherat
authors: Robert
authors: R
authors: Cohen
mesh_terms: D000553:Ambulatory Care / Q000379:methods*; D015415:Biomarkers / Q000097:blood; D001903:Bottle Feeding; D001988:Bronchiolitis / Q000097:blood / Q000150:complications*; D004435:Eating; D006760:Hospitalization; D006801:Humans; D000860:Hypoxia / Q000097:blood / Q000175:diagnosis* / Q000209:etiology; D007223:Infant; D007231:Infant, Newborn; D016015:Logistic Models; D015999:Multivariate Analysis; D016017:Odds Ratio; D010100:Oxygen / Q000097:blood; D011446:Prospective Studies; D012680:Sensitivity and Specificity
chemical_list: D015415:Biomarkers; D010100:Oxygen