Elsevier

The Journal of Pediatrics

Volume 151, Issue 3, September 2007, Pages 266-270.e1
The Journal of Pediatrics

Original article
Nebulized Hypertonic Saline in the Treatment of Viral Bronchiolitis in Infants

https://doi.org/10.1016/j.jpeds.2007.04.010Get rights and content

Objective

To investigate the use of nebulized 3% hypertonic saline (HS) for treating viral bronchiolitis in moderately ill hospitalized infants by a prospective, randomized, double-blinded, controlled, multicenter trial.

Study design

A total of 96 infants (mean age, 4.7 months; range, 0.3 to 18 months) admitted to the hospital for treatment of viral bronchiolitis were recruited from 3 regional pediatric centers over 3 bronchiolitis seasons (December 2003 to May 2006). Patients were randomized to receive, in a double-blind fashion, repeated doses of nebulized 3% HS (treatment group) or 0.9% normal saline (NS; control group), in addition to routine therapy ordered by the attending physician. The principal outcome measure was hospital length of stay (LOS).

Results

On an intention-to-treat basis, the infants in the HS group had a clinically relevant 26% reduction in LOS to 2.6 ± 1.9 days, compared with 3.5 ± 2.9 days in the NS group (P = .05). The treatment was well tolerated, with no adverse effects attributable to the use of HS.

Conclusions

The use of nebulized 3% HS is a safe, inexpensive, and effective treatment for infants hospitalized with moderately severe viral bronchiolitis.

Section snippets

Patients

Infants up to age 18 months who were admitted to the hospital for the treatment of moderately severe viral bronchiolitis were eligible for study. The diagnosis of moderately severe bronchiolitis required a history of a preceding viral upper respiratory infection, the presence of wheezing or crackles on chest auscultation, plus either an oxygen saturation (SaO2) of <94% in room air or significant respiratory distress as measured by a Respiratory Distress Assessment Instrument (RDAI)34 score of

Study Population

A total of 96 previously well infants (mean age, 4.7 ± 4.2 months; range, 10 days to 18 months) with viral bronchiolitis were enrolled from 3 centers during the bronchiolitis seasons from December 2003 to May 2006. Thirty-two infants were enrolled from the 2 Canadian sites (VGH and KGH), and 64 infants were enrolled from SKMC. Forty-seven infants were randomized to the HS treatment group, and 49 were randomized to the NS control group. Five infants (2 from the HS group and 3 from the NS group)

Discussion

This study demonstrates that inhaled 3% HS is an effective treatment for infants up to age 18 months hospitalized with viral bronchiolitis. Repeated inhalations of nebulized HS reduced the LOS by approximately 1 day, from 3.5 ± 2.9 to 2.6 ± 1.9 days. This is a clinically relevant benefit with the potential for widespread impact on the treatment of bronchiolitis.

The infants that we studied came from a population that was geographically and ethnically very diverse. Nevertheless, these infants

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    Supported by the Queen Alexandra Foundation for Children, British Columbia, Canada; Vancouver Island Health Authority, Youth and Maternal Programme, British Columbia, Canada; and an Ontario Thoracic Society block term grant.

    No reprint requests are available from the authors.

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