Bronchiolitis is common and often requires hospitalisation. There is considerable debate about the efficacy of specific interventions, particularly inhalational therapy. Skjerven et al (N Engl J Med 2013;368 : 2286–93) have reported the outcome of an eight centre, double blind trial with 2 by 2 factorial design. Racemic adrenalin was compared with inhaled saline and on demand inhalation with a fixed schedule (2 hourly) in infants admitted with moderate to severe bronchiolitis. Primary outcome was length of stay. Four hundred and four infants were recruited, median age 4 months. Length of stay, use of oxygen supplements, nasogastric tube feeding, and improvement in clinical scores were similar in groups treated with inhaled adrenalin and inhaled saline. On demand (rather than fixed schedule) inhalation was associated with a shorter length of stay (47.6 h, 95% CI 30.6 to 64.6 vs 61.3 h, 95% CI 45.4 to 77.2) as well as less oxygen supplementation, less use of ventilatory support and fewer inhaled treatments. The authors conclude that inhaled adrenalin is no more effective than saline in this setting and inhalation (if used) is more effective ‘on demand’ rather than using a fixed schedule.

Maternal vitamin D status in pregnancy is felt to be a determinant …