Elsevier

The Journal of Pediatrics

Volume 157, Issue 4, October 2010, Pages 630-634.e1
The Journal of Pediatrics

Original Article
Nebulized 5% or 3% Hypertonic or 0.9% Saline for Treating Acute Bronchiolitis in Infants

https://doi.org/10.1016/j.jpeds.2010.04.074Get rights and content

Objective

To compare the efficacy and safety of 5%, 3%, and 0.9% saline solution for treating acute bronchiolitis in the prehospital setting.

Study design

This was a double-blind trial including consecutive infants aged <18 months treated in an urban urgent care setting. A total of 165 patients were randomized to receive nebulized 5%, 3%, or 0.9% (normal) saline with epinephrine every 4 hours. The primary efficacy outcome was bronchiolitis severity score improvement at 48 hours (χ2 analysis). Scores and oxygen saturation immediately before and after each treatment were recorded to assess safety.

Results

A total of 187 previously healthy infants (median age, 3.1 months) diagnosed with bronchiolitis were enrolled. Positivity for respiratory syncytial virus was similar in the 3 treatment groups (mean, 56%). At 48 hours, the mean severity score for the 5% saline group was 3.69 ± 1.09, and that for the 0.9% saline group was 4.12 ± 1.11 (P = .04; difference, 0.43, 95% confidence interval for the difference, 0.02-0.88). The mean severity score for the 3% saline group was intermediate at 4.00 ± 1.22. Revisit rates after discharge were similar in the 3 treatment groups. No adverse reactions or other safety concerns were identified.

Conclusions

Nebulization with 5% hypertonic saline is safe, can be widely generalizable, and may be superior to current treatment for early outpatient treatment of bronchiolitis.

Section snippets

Methods

We conducted a double-blinded, randomized, parallel-group clinical trial to compare the efficacy and safety of 5% and 3% hypertonic saline versus 0.9% (normal) saline for the treatment of acute bronchiolitis. The study was conducted between September 2007 and December 2008 in the short-stay unit of the Pediatric Emergency Center of Hamad General Hospital, the only pediatric emergency facility in Qatar. The center serves an average of 200 000 patients annually and manages 42 beds in a short-stay

Results

A total of 187 previously healthy infants diagnosed with viral bronchiolitis, median age 3.1 months (range, 9 days to 14.7 months), were enrolled in the study. Sixteen infants were excluded from the analysis; 9 should have been excluded from enrollment (4 born at ≤34 weeks' gestational age, 2 with a history of apnea with cyanosis before enrollment, 1 with previously known severe laryngomalacia, and 2 who had received steroids within 24 hours before enrollment), 1 infant was enrolled twice in

Discussion

In our study group, nebulization with 5% hypertonic saline proved superior to 0.9% saline for improving the bronchiolitis severity score in patients with viral bronchiolitis in the early treatment setting, and possibly superior to 3% saline as well. If our results are confirmed, we believe this simple, inexpensive, easily applied, safe, and apparently effective treatment could be generalized for use worldwide in clinics, infirmaries, and hospitals caring for pediatric patients. Bronchiolitis

References (19)

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Supported by Hamad Medical Corporation which employs all of the physicians except B.D., who also worked at Hamad. The authors declare no conflicts of interest.

Registered at clinicaltrials.gov: ID# NCT01016249.

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