Sa0₂ monitoring in bronchiolitis

As our wards fill up with infants with bronchiolitis this winter, most will be permanently attached to oxygen saturation monitors: staff and parents will stare at the monitor, sometimes neglecting to look at the baby. Some bronchiolitis management guidelines recommend only intermittent saturation (Sa0₂) measurements. Researchers from four US children's hospitals set out to see if this was acceptable (McCulloh et al. JAMA Peds 2015. doi:10.1001/jamapediatrics.2015.1746). They randomised around 160 infants with bronchiolitis who were not hypoxic initially: they received either continuous monitoring, or intermittent checks at the time of regular observations or if visibly deteriorating. On the outcome measures used—length of stay, duration of supplemental oxygen, escalation to intensive care—there was no difference between the groups.

An accompanying editorial supports the conclusion that clinical observation is best, and warns against extrapolating from Sa0₂ monitoring policies and target ranges used in other conditions (Cunningham S. doi:10.1001/jamapediatrics.2015.1971). Bronchiolitis is usually benign and self-limiting, and the baby's ability to feed, not an arbitrary saturation level, is the best indicator of status.

Starting solids and growth

We are frequently asked to advise on what age infants should receive their first solid food, and opinions on the …