{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T06:42:56Z","timestamp":1792392176783,"version":"4.4.0"},"reference-count":29,"publisher":"Ovid Technologies (Wolters Kluwer Health)","license":[{"start":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T00:00:00Z","timestamp":1792368000000},"content-version":"unspecified","delay-in-days":0,"URL":"http:\/\/creativecommons.org\/licenses\/by-nc-nd\/4.0\/"}],"content-domain":{"domain":["lww.com","ovid.com"],"crossmark-restriction":true},"short-container-title":[],"abstract":"<jats:sec>\n                    <jats:title>Background:<\/jats:title>\n                    <jats:p>Predictive analytics using continuously measured vital signs from bedside monitors has improved outcomes in critically ill children. We investigated whether continuous pulse oximetry data collected during emergency department (ED) evaluation can identify infants \u226490 days old with bronchiolitis at low risk of respiratory deterioration.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Methods:<\/jats:title>\n                    <jats:p>We conducted a single-center retrospective cohort study of infants \u226490 days old with bronchiolitis who presented to a tertiary-care pediatric ED from November 2021 to November 2025. Infants were identified using the ICD-10 code with manual eligibility confirmation. Heart rate and oxygen saturation features were generated from continuous pulse oximetry during the first 2 hours of ED evaluation. The primary outcome was respiratory deterioration within 24 hours of ED arrival, defined as initiation of high-flow nasal cannula, continuous\/bilevel positive airway pressure, or invasive mechanical ventilation. Data were split into derivation and validation cohorts (70\/30, stratified by outcome). An L2-regularized logistic regression model estimated the probability of respiratory deterioration, with a classification threshold selected to prioritize sensitivity.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results:<\/jats:title>\n                    <jats:p>Of 290 infants meeting clinical eligibility, 117 had sufficient continuous pulse oximetry data; 57 (49%) had respiratory deterioration. The primary model included 3 features: the median and interquartile range (IQR) of heart rate, and oxygen saturation IQR. In the validation cohort, the model showed moderate sensitivity (0.78, 95% CI: 0.58-0.95) and fair discrimination (AUROC=0.78, 95% CI: 0.62-0.93).<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusion:<\/jats:title>\n                    <jats:p>We derived and validated a model using data from continuous pulse oximetry to identify low-risk infants with bronchiolitis. With further refinement and integration into monitor design systems, this approach may enhance clinical utility of continuous pulse oximetry.<\/jats:p>\n                  <\/jats:sec>","DOI":"10.1097\/pec.0000000000003735","type":"journal-article","created":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T06:00:15Z","timestamp":1792389615000},"update-policy":"https:\/\/doi.org\/10.1097\/lww.0000000000001000","source":"Crossref","is-referenced-by-count":0,"title":["Continuous Pulse Oximetry Analysis to Predict Outcomes in Young Infants With Bronchiolitis Presenting to the Emergency Department"],"prefix":"10.1097","author":[{"given":"Son H.","family":"McLaren","sequence":"first","affiliation":[{"name":"Emergency Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Murad","family":"Megjhani","sequence":"additional","affiliation":[{"name":"Neurology, Program for Hospital and Intensive Care Informatics"},{"name":"Computer Science, Barnard College, Columbia University"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Carlos A.","family":"Camargo","sequence":"additional","affiliation":[{"name":"Emergency Medicine, Massachusetts General Hospital, Harvard Medical School, Boston, MA"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Todd A.","family":"Florin","sequence":"additional","affiliation":[{"name":"Pediatrics, Division of Pediatric Emergency Medicine, Northwestern University Feinberg School of Medicine, Ann and Robert H. Lurie Children\u2019s Hospital of Chicago, Chicago, IL"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Cheng-Shiun","family":"Leu","sequence":"additional","affiliation":[{"name":"Biostatistics, Mailman School of Public Health"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Asuncion","family":"Mejias","sequence":"additional","affiliation":[{"name":"Infectious Diseases, St. Jude Children\u2019s Hospital, Memphis, TN"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Rakesh","family":"Sahni","sequence":"additional","affiliation":[{"name":"Pediatrics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tammam","family":"Alalqum","sequence":"additional","affiliation":[{"name":"Neurology, Program for Hospital and Intensive Care Informatics"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel","family":"Fenster","sequence":"additional","affiliation":[{"name":"Emergency Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daniel A.","family":"Green","sequence":"additional","affiliation":[{"name":"Pathology"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Marlin V.","family":"Morel","sequence":"additional","affiliation":[{"name":"Emergency Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Oliver","family":"Simpson","sequence":"additional","affiliation":[{"name":"Emergency Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Peter S.","family":"Dayan","sequence":"additional","affiliation":[{"name":"Emergency Medicine"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Soojin","family":"Park","sequence":"additional","affiliation":[{"name":"Neurology, Program for Hospital and Intensive Care Informatics"},{"name":"Biomedical Informatics, Columbia University Vagelos College of Physicians and Surgeons, New York, NY"}],"role":[{"vocabulary":"crossref","role":"author"}]}],"member":"276","published-online":{"date-parts":[[2026,10,19]]},"reference":[{"key":"R1-20261019","doi-asserted-by":"crossref","first-page":"e20174253","DOI":"10.1542\/peds.2017-4253","article-title":"Predicting escalated care in infants with bronchiolitis","volume":"142","author":"Freire","year":"2018","journal-title":"Pediatrics"},{"key":"R2-20261019","doi-asserted-by":"crossref","first-page":"680","DOI":"10.1542\/peds.2007-1418","article-title":"Prospective multicenter study of bronchiolitis: predicting safe discharges from the emergency department","volume":"121","author":"Mansbach","year":"2008","journal-title":"Pediatrics"},{"key":"R3-20261019","doi-asserted-by":"crossref","first-page":"e492","DOI":"10.1542\/peds.2012-0444","article-title":"Prospective multicenter study of children with bronchiolitis requiring mechanical ventilation","volume":"130","author":"Mansbach","year":"2012","journal-title":"Pediatrics"},{"key":"R4-20261019","doi-asserted-by":"crossref","first-page":"116","DOI":"10.1097\/INF.0000000000002914","article-title":"Age-dependent interactions among clinical characteristics, viral loads and disease severity in young children with respiratory syncytial virus infection","volume":"40","author":"Brenes-Chacon","year":"2021","journal-title":"Pediatr Infect Dis J"},{"key":"R5-20261019","doi-asserted-by":"crossref","first-page":"e254666","DOI":"10.1001\/jamanetworkopen.2025.4666","article-title":"Risk factors for severe disease among children hospitalized with respiratory syncytial virus","volume":"8","author":"Kirolos","year":"2025","journal-title":"JAMA Netw Open"},{"key":"R6-20261019","doi-asserted-by":"crossref","first-page":"5420","DOI":"10.3390\/jcm14155420","article-title":"The path of bronchiolitis towards intensive care: risk factor analysis in a large Italian cohort","volume":"14","author":"Maglione","year":"2025","journal-title":"J Clin Med"},{"key":"R7-20261019","doi-asserted-by":"crossref","first-page":"1041","DOI":"10.1016\/S0140-6736(15)00163-4","article-title":"Oxygen saturation targets in infants with bronchiolitis (BIDS): a double-blind, randomised, equivalence trial","volume":"386","author":"Cunningham","year":"2015","journal-title":"Lancet"},{"key":"R8-20261019","doi-asserted-by":"crossref","first-page":"e45","DOI":"10.1542\/peds.111.1.e45","article-title":"Bronchiolitis management preferences and the influence of pulse oximetry and respiratory rate on the decision to admit","volume":"111","author":"Mallory","year":"2003","journal-title":"Pediatrics"},{"key":"R9-20261019","doi-asserted-by":"crossref","first-page":"527","DOI":"10.1001\/archpedi.158.6.527","article-title":"Impact of pulse oximetry and oxygen therapy on length of stay in bronchiolitis hospitalizations","volume":"158","author":"Schroeder","year":"2004","journal-title":"Arch Pediatr Adolesc Med"},{"key":"R10-20261019","doi-asserted-by":"crossref","first-page":"470","DOI":"10.1542\/peds.2007-1135","article-title":"Effect of oxygen supplementation on length of stay for infants hospitalized with acute viral bronchiolitis","volume":"121","author":"Unger","year":"2008","journal-title":"Pediatrics"},{"key":"R11-20261019","doi-asserted-by":"crossref","first-page":"e1474","DOI":"10.1542\/peds.2014-2742","article-title":"Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis","volume":"134","author":"Ralston","year":"2014","journal-title":"Pediatrics"},{"key":"R12-20261019","doi-asserted-by":"crossref","first-page":"210","DOI":"10.1038\/s41390-019-0527-0","article-title":"Continuous vital sign analysis for predicting and preventing neonatal diseases in the twenty-first century: big data to the forefront","volume":"87","author":"Kumar","year":"2020","journal-title":"Pediatr Res"},{"key":"R13-20261019","doi-asserted-by":"crossref","first-page":"1370","DOI":"10.1161\/STROKEAHA.120.032546","article-title":"Dynamic detection of delayed cerebral ischemia: a study in 3 centers","volume":"52","author":"Megjhani","year":"2021","journal-title":"Stroke"},{"key":"R14-20261019","doi-asserted-by":"crossref","first-page":"122","DOI":"10.3389\/fneur.2018.00122","article-title":"Incorporating high-frequency physiologic data using computational dictionary learning improves prediction of delayed cerebral ischemia compared to existing methods","volume":"9","author":"Megjhani","year":"2018","journal-title":"Front Neurol"},{"key":"R15-20261019","doi-asserted-by":"crossref","first-page":"463","DOI":"10.1055\/s-0037-1608709","article-title":"Cross-correlation of heart rate and oxygen saturation in very low birthweight infants: association with apnea and adverse events","volume":"35","author":"Fairchild","year":"2018","journal-title":"Am J Perinatol"},{"key":"R16-20261019","doi-asserted-by":"crossref","first-page":"315","DOI":"10.1038\/pr.2016.215","article-title":"Vital signs and their cross-correlation in sepsis and NEC: a study of 1065 very-low-birth-weight infants in two NICUs","volume":"81","author":"Fairchild","year":"2017","journal-title":"Pediatr Res"},{"key":"R17-20261019","doi-asserted-by":"crossref","first-page":"1639","DOI":"10.1097\/CCM.0000000000001738","article-title":"Signatures of subacute potentially catastrophic illness in the ICU: model development and validation","volume":"44","author":"Moss","year":"2016","journal-title":"Crit Care Med"},{"key":"R18-20261019","doi-asserted-by":"crossref","first-page":"e101880","DOI":"10.1136\/bmjopen-2025-101880","article-title":"Young infants with bronchiolitis at low risk of respiratory deterioration in an urban, academic emergency department: prospective cohort study protocol","volume":"15","author":"McLaren","year":"2025","journal-title":"BMJ Open"},{"key":"R19-20261019","doi-asserted-by":"crossref","first-page":"172","DOI":"10.1097\/MOP.0b013e32835e8fe6","article-title":"Predictive monitoring for early detection of sepsis in neonatal ICU patients","volume":"25","author":"Fairchild","year":"2013","journal-title":"Curr Opin Pediatr"},{"key":"R20-20261019","doi-asserted-by":"crossref","first-page":"553","DOI":"10.3233\/NPM-200578","article-title":"Clinical and vital sign changes associated with late-onset sepsis in very low birth weight infants at 3 NICUs","volume":"14","author":"Sullivan","year":"2021","journal-title":"J Neonatal Perinatal Med"},{"key":"R22-20261019","doi-asserted-by":"crossref","first-page":"1197","DOI":"10.1111\/jpc.70144","article-title":"Australasian bronchiolitis guideline: 2025 update","volume":"61","author":"Borland","year":"2025","journal-title":"J Paediatr Child Health"},{"key":"R24-20261019","doi-asserted-by":"crossref","first-page":"898","DOI":"10.1001\/jamapediatrics.2015.1746","article-title":"Use of intermittent vs continuous pulse oximetry for nonhypoxemic infants and young children hospitalized for bronchiolitis: a randomized clinical trial","volume":"169","author":"McCulloh","year":"2015","journal-title":"JAMA Pediatr"},{"key":"R25-20261019","doi-asserted-by":"crossref","first-page":"466","DOI":"10.1001\/jamapediatrics.2020.6141","article-title":"Intermittent vs continuous pulse oximetry in hospitalized infants with stabilized bronchiolitis: a randomized clinical trial","volume":"175","author":"Mahant","year":"2021","journal-title":"JAMA Pediatr"},{"key":"R26-20261019","doi-asserted-by":"crossref","first-page":"e2243609","DOI":"10.1001\/jamanetworkopen.2022.43609","article-title":"Cost-effectiveness of intermittent vs continuous pulse oximetry monitoring in infants hospitalized with stabilized bronchiolitis","volume":"5","author":"Moretti","year":"2022","journal-title":"JAMA Netw Open"},{"key":"R27-20261019","doi-asserted-by":"crossref","first-page":"e2030905","DOI":"10.1001\/jamanetworkopen.2020.30905","article-title":"Frequency, timing, risk factors, and outcomes of desaturation in infants with acute bronchiolitis and initially normal oxygen saturation","volume":"3","author":"Stollar","year":"2020","journal-title":"JAMA Netw Open"},{"key":"R28-20261019","doi-asserted-by":"crossref","first-page":"602","DOI":"10.1001\/jamapediatrics.2016.0114","article-title":"Effect of oxygen desaturations on subsequent medical visits in infants discharged from the emergency department with bronchiolitis","volume":"170","author":"Principi","year":"2016","journal-title":"JAMA Pediatr"},{"key":"R29-20261019","doi-asserted-by":"crossref","first-page":"97","DOI":"10.1542\/peds.107.1.97","article-title":"Toward the early diagnosis of neonatal sepsis and sepsis-like illness using novel heart rate analysis","volume":"107","author":"Griffin","year":"2001","journal-title":"Pediatrics"},{"key":"R30-20261019","doi-asserted-by":"crossref","first-page":"416","DOI":"10.1097\/SHK.0000000000001192","article-title":"Heart rate variability, clinical and laboratory measures to predict future deterioration in patients presenting with sepsis","volume":"51","author":"Barnaby","year":"2019","journal-title":"Shock"},{"key":"R31-20261019","doi-asserted-by":"crossref","first-page":"540","DOI":"10.1001\/jamapediatrics.2023.0071","article-title":"Evaluating the accuracy of pulse oximetry in children according to race","volume":"177","author":"Ruppel","year":"2023","journal-title":"JAMA Pediatr"}],"container-title":["Pediatric Emergency Care"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.ovid.com\/10.1097\/PEC.0000000000003735","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2026,10,19]],"date-time":"2026-10-19T06:00:18Z","timestamp":1792389618000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.ovid.com\/10.1097\/PEC.0000000000003735"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2026,10,19]]},"references-count":29,"URL":"https:\/\/doi.org\/10.1097\/pec.0000000000003735","relation":{},"ISSN":["0749-5161","1535-1815"],"issn-type":[{"value":"0749-5161","type":"print"},{"value":"1535-1815","type":"electronic"}],"subject":[],"published":{"date-parts":[[2026,10,19]]},"assertion":[{"value":"2026-08-14","name":"received","label":"Received","group":{"name":"publication_history","label":"Publication History"}},{"value":"2026-09-25","name":"accepted","label":"Accepted","group":{"name":"publication_history","label":"Publication History"}}]}}