TOP 46 - How soon is too soon? The association between observation time off supplemental oxygen and readmission rates for infants hospitalized with bronchiolitis

Publication Number: 2798.TOP 46

Lauren Amendola, Advocate Children's Hospital, Orland Park, IL, United States; Emma Flosi, Advocate Children's Hospital - Oak Lawn, Orland Park, IL, United States; Matthew Silas, Advocate Children's Hospital - Oak Lawn, Oak Lawn, IL, United States; Loredana C.. Huma, Advocate Children's Hospital - Park Ridge, Northfield, IL, United States; Hasan Mahbubul, AAH, Collierville, TN, United States; Sheena McKenzie, Advocate Children's Hospital - Oak Lawn, Chicago, IL, United States

Background: High-flow nasal cannula (HFNC) and low-flow nasal cannula (LFNC) are widely used in the management of bronchiolitis, the leading cause of infant hospitalization. Limited evidence informs the optimal duration of monitoring after discontinuing supplemental oxygen before discharge, resulting in wide practice variation. Clinicians must balance the risk of readmission from early discharge against the costs of prolonged hospitalization. Factors such as patient age, viral pathogen, and final oxygen modality may influence observation time off oxygen. We aim to examine the association between duration of monitoring off supplemental oxygen with readmission rates and patient characteristics in infants hospitalized with bronchiolitis.

Objective: Our primary objective is to determine whether the duration of monitoring patients hospitalized with bronchiolitis off supplemental oxygen prior to discharge is associated with differences in 7-day and 30-day hospital readmission or emergency department (ED) visit rates. Our secondary objective is to assess how the following patient and illness characteristics are associated with observation time off oxygen: age, history of prematurity, last oxygen modality used (HFNC or LFNC), viral pathogen, time of day of oxygen discontinuation, rapid response during index hospitalization (IH), continuous intravenous fluids or nasogastric feeds during IH, and hospital length of stay.

Design/Methods: This Institutional Review Board-approved retrospective cohort study includes 970 patients aged 0-24 months hospitalized with bronchiolitis requiring supplemental oxygen between November 1, 2022 and November 30, 2024 at two tertiary children’s hospitals in the Chicago area. Patients will be identified using ICD-10 codes for bronchiolitis. Exclusion criteria include intensive care unit admission, concurrent diagnoses of asthma, croup, or pneumonia, and patients with chronic lung disease, cardiac disease, home oxygen dependence, or gastrostomy tube dependence. Logistic regression models will assess the association between duration of monitoring off supplemental oxygen and revisit/readmission rates, factoring in variables such as age, viral pathogen, and final oxygen modality. Linear relationships between patient characteristics and duration of monitoring off oxygen will be assessed through Pearson correlation, followed by linear regression to account for the time of oxygen discontinuation and rapid response during IH. Analyses will be performed by a biostatistician using R and RStudio, with significance defined as p < 0.05. Data analysis will be completed by January 2026.