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Nebulised hypertonic saline (3%) among children with mild to moderately severe bronchiolitis--a double blind
Aayush Khanal1, Arun Sharma2, Srijana Basnet3
1Department of Pediatrics, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj-44600, P.O. Box 1524, Kathmandu, Nepal. aayush_khanal@iom.edu.np.
Insights
Nebulized 3% hypertonic saline (HS) significantly improves clinical severity scores in infants with mild to moderate bronchiolitis. This treatment facilitates earlier discharge and reduces hospital re-visits compared to normal saline.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Clinical Trials
Background:
- Bronchiolitis is a common viral respiratory infection in infants.
- Mild to moderate cases are typically managed in outpatient settings.
- Current management often focuses on supportive care.
Purpose of the Study:
- To evaluate the efficacy of nebulized 3% hypertonic saline (HS) in children with mild to moderately severe bronchiolitis.
- To compare HS with normal saline (NS) in improving clinical severity scores and facilitating early discharge.
Main Methods:
- A double-blind, randomized controlled trial enrolled 100 infants (6 weeks to 24 months) with mild to moderate bronchiolitis.
- Participants received two doses of nebulized 3% HS or 0.9% NS, 30 minutes apart.
- The primary outcome was the change in clinical severity score at 2 hours post-treatment.
Main Results:
- The 3% HS group showed a significantly greater reduction in mean clinical severity score compared to the NS group (p < 0.001).
- More infants in the HS group were discharged within 2 hours (70% vs. 30%, p < 0.001).
- Hospital re-visits within 24 hours were less frequent in the HS group (10% vs. 30%, p < 0.001).
Conclusions:
- Nebulized 3% HS is an effective and safe treatment for mild to moderate viral bronchiolitis in infants.
- HS superior to NS in improving clinical scores, enabling early discharge, and reducing re-visits.
- The treatment was well-tolerated with no reported adverse effects.
Background:
To Assess the efficacy of nebulised hypertonic saline (HS) (3%) among children with mild to moderately severe bronchiolitis.
Methods:
Infants aged 6 weeks to 24 months, with a first episode of wheezing and Clinical Severity scores (Arch Dis Child 67:289-93, 1992) between 1 and 8, were enrolled over 4 months duration. Those with severe disease, co-morbidities, prior wheezing, recent bronchodilator and steroid use were excluded. Patients were randomized in a double-blind fashion, to receive two doses of nebulized 3% HS (Group 1) or 0.9% normal saline (Group 2) with 1.5 mg of L-Epineprine, delivered 30 min apart. Parents were contacted at 24 h and 7 days. The principal outcome measure was the mean change in clinical severity score at the end of 2 h of observation.
Results:
A total of 100 infants (mean age 9.6 months, range 2-23 months; 61 % males) were enrolled. Patients in both groups had mild to moderately severe disease at presentation. On an intention-to-treat basis, the infants in the HS group had a significant reduction (3.57 ± 1.41) in the mean clinical severity score compared to those in the NS group (2.26 ± 1.15); [p < 0.001; CI: 0.78-1.82]. More children in the HS group (n = 35/50; 70.0%) were eligible for ER/OPD discharge at the end of 2 h than those in the NS group (n = 15/50; 30%; p < 0.001), and less likely to need a hospital re-visit (n = 5/50; 10.0%) in the next 24 h as compared to the NS group (n = 15/50, 30.0%; p < 0.001). The treatment was well tolerated, with no adverse effects.
Conclusions:
Nebulized 3% HS is effective, safe and superior to normal saline for outpatient management of infants with mild to moderately severe viral bronchiolitis in improving Clinical Severity Scores, facilitating early Out-Patient Department discharge and preventing hospital re-visits and admissions in the 24 h of presentation.
Trial Registration:
Clinicaltrials.gov NCTID012766821. Registered on January 12, 2011.
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