Oxygen saturation targets in infants with bronchiolitis

1016 www.thelancet.com Vol 386 September 12, 2015 Acute viral bronchiolitis is associated with lower respiratory tract infections in infants. Although generally self-limiting and managed in the community, acute viral bronchiolitis is the most common cause of hospital admission in infants younger than 12 months of age, and is associated with substantial morbidity and health-care costs. Admissions of infants to hospital for bronchiolitis have increased in the past 20 years for reasons that might be multifactorial, although the use of pulse oximeters and insuffi cient evidence and clarity about levels of tolerable hypoxaemia are thought to be associated with increased admission rates. Additionally, duration of hospital stay seems to be determined by the requirement for oxygen supplementation, even when feeding problems have resolved. National guidelines in the USA and UK diff er in their recommendations for supplemental oxygen to target acceptable saturations (SpO2) of 90% or higher, or 94% or higher, respectively. An observational study in bronchiolitis previously suggested that length of stay could be reduced when lower oxygen cutoff s were chosen, setting the stage for the randomised BIDS trial now reported by Steve Cunningham and colleagues in The Lancet, which provides welcome evidence about the use of supplemental oxygen and oxygen saturation targets in bronchiolitis. Oxygen saturation targets in infants with bronchiolitis capacity for emergency response among local health providers and populations. Finally, academics among the diaspora should work to quantify the important work that diaspora health workers are doing to gain further legitimacy as a force for good in global health. Whereas a plethora of scholarly work has focused on migration by health workers, there is a dearth of high-quality research that investigates the contributions of diaspora health workers in health system strengthening in LMICs. There is an urgent need for all stakeholders— governments in LMICs and high-income countries, non-profi t organisations, academic institutions, and development agencies—to create a blueprint that lays down clear strategies for the organisation, preparation, and engagement of diaspora health workers in health system strengthening and emergency preparedness. Diaspora health workers deserve an integrated platform and organised opportunities to develop meaningful, long-term, and sustainable engagements that improve health in LMICs, during times of crisis and beyond.