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The AAP, in conjunction with the American Academy of Family Physicians (AAFP), the American College of Chest Physicians (ACCP), and the American Thoracic Society (ATS), published the following recommendations for admission for patients with bronchiolitis:
- Persistent resting oxygen saturation below 92% in room air before beta-agonist trial (be sure to watch the patient sleeping, as the O2 saturation can drop even further)
- Markedly elevated respiratory rate (> 70-80 breaths per min)
- Dyspnea and intercostal retractions, indicating respiratory distress
- Desaturation on 40% oxygen (3-4 L/min oxygen), cyanosis
- Chronic lung disease, especially if the patient is on supplemental oxygen
- Congenital heart disease, especially if associated with cyanosis or pulmonary hypertension
- Prematurity
- Age younger than 3 months, when severe disease is most common
- Inability to maintain oral hydration in patients younger than 6 months
- Difficulty feeding as a consequence of respiratory distress
- Parent unable to care for child at home
Reference:
Diagnosis and management of bronchiolitis. Pediatrics. Oct 2006;118(4):1774-93.