Recommended Citation
Amendola L, Flosi E, Silas M, Huma L, Mahbubul H, McKenzie S. How Soon is Too Soon? The Association Between Observation Time off Supplemental Oxygen and Readmission Rates for Infants Hospitalized with Bronchiolitis. Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Abstract
Background/Significance:
High-flow nasal cannula and low-flow nasal cannula are widely used in bronchiolitis, the leading cause of infant hospitalization. Limited evidence informs optimal duration of monitoring after discontinuing oxygen before discharge, resulting in wide practice variation.
Purpose:
Our primary objective was to determine if the duration of monitoring patients with bronchiolitis off supplemental oxygen before discharge was associated with differences in 7- and 30-day emergency department (ED) visit or hospital readmission rates. Our secondary objective was to assess how the following characteristics are associated with observation time off oxygen: age, prematurity, last oxygen modality used, viral pathogen, time of oxygen discontinuation, intravenous fluids (IVF) or nasogastric (NG) feeds during hospitalization, and length of stay.
Methods:
This retrospective cohort study included 970 patients 0-24 months admitted with bronchiolitis (identified by ICD-10 codes) on the general pediatric floor at both campuses of Advocate Children’s Hospital between 11/1/2022-11/30/2024. Observation time off oxygen was divided into 6 groups for analysis (1-3.9, 4-5.9, 6-7.9, 8-11.9, 12-23.9, and 24+ hours). Logistic regression models assessed association between time off oxygen and revisit rates. Linear relationships between patient characteristics and time off oxygen were assessed through Pearson correlation. Significance was defined as p < 0.05.
Results:
Across the 6 groups of observation times, there were no significant differences in 7-day all cause or respiratory related ED visit or readmission rates (all p > 0.45). 30-day respiratory ED visits showed a difference across groups (p = 0.020), with the 8-11.9 hour group having the highest rate, although absolute differences were small. Younger age and use of IVF or NG feeds were associated with longer observation off oxygen. Median age was 6 months in the 24+ hour observation group, compared to 11 months in the 0-3.9 hour group.
Conclusion:
In this retrospective cohort study of infants with bronchiolitis, shorter observation time off oxygen was not associated with increased risk of 7- or 30-day ED visit or readmission rates. This represents an area in which providers may safely do less. Younger patients and those with concurrent dehydration/feeding difficulties were observed longer. Further studies are needed to inform the optimal observation of time off oxygen in bronchiolitis.
Presentation Notes
Presented at Scientific Day; May 20, 2026; Milwaukee, WI.
Full Text of Presentation
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Document Type
Oral/Podium Presentation
How Soon is Too Soon? The Association Between Observation Time off Supplemental Oxygen and Readmission Rates for Infants Hospitalized with Bronchiolitis
Background/Significance:
High-flow nasal cannula and low-flow nasal cannula are widely used in bronchiolitis, the leading cause of infant hospitalization. Limited evidence informs optimal duration of monitoring after discontinuing oxygen before discharge, resulting in wide practice variation.
Purpose:
Our primary objective was to determine if the duration of monitoring patients with bronchiolitis off supplemental oxygen before discharge was associated with differences in 7- and 30-day emergency department (ED) visit or hospital readmission rates. Our secondary objective was to assess how the following characteristics are associated with observation time off oxygen: age, prematurity, last oxygen modality used, viral pathogen, time of oxygen discontinuation, intravenous fluids (IVF) or nasogastric (NG) feeds during hospitalization, and length of stay.
Methods:
This retrospective cohort study included 970 patients 0-24 months admitted with bronchiolitis (identified by ICD-10 codes) on the general pediatric floor at both campuses of Advocate Children’s Hospital between 11/1/2022-11/30/2024. Observation time off oxygen was divided into 6 groups for analysis (1-3.9, 4-5.9, 6-7.9, 8-11.9, 12-23.9, and 24+ hours). Logistic regression models assessed association between time off oxygen and revisit rates. Linear relationships between patient characteristics and time off oxygen were assessed through Pearson correlation. Significance was defined as p < 0.05.
Results:
Across the 6 groups of observation times, there were no significant differences in 7-day all cause or respiratory related ED visit or readmission rates (all p > 0.45). 30-day respiratory ED visits showed a difference across groups (p = 0.020), with the 8-11.9 hour group having the highest rate, although absolute differences were small. Younger age and use of IVF or NG feeds were associated with longer observation off oxygen. Median age was 6 months in the 24+ hour observation group, compared to 11 months in the 0-3.9 hour group.
Conclusion:
In this retrospective cohort study of infants with bronchiolitis, shorter observation time off oxygen was not associated with increased risk of 7- or 30-day ED visit or readmission rates. This represents an area in which providers may safely do less. Younger patients and those with concurrent dehydration/feeding difficulties were observed longer. Further studies are needed to inform the optimal observation of time off oxygen in bronchiolitis.
Affiliations
Advocate Children's Hospital, Advocate Lutheran General Hospital