a abstract BACKGROUND AND OBJECTIVES: Bronchiolitis, the most common reason for hospitalization in children younger than 1 year in the United States, has no proven therapies effective beyond supportive care. We aimed to investigate the effect of nebulized 3% hypertonic saline (HS) compared with nebulized normal saline (NS) on length of stay (LOS) in infants hospitalized with bronchiolitis. METHODS:We conducted a prospective, randomized, double-blind, controlled trial in an urban tertiary care children's hospital in 227 infants younger than 12 months old admitted with a diagnosis of bronchiolitis (190 completed the study); 113 infants were randomized to HS (93 completed the study), and 114 to NS (97 completed the study). Subjects received 4 mL nebulized 3% HS or 4 mL 0.9% NS every 4 hours from enrollment until hospital discharge. The primary outcome was median LOS. Secondary outcomes were total adverse events, subdivided as clinical worsening and readmissions.RESULTS: Patient characteristics were similar in groups. In intention-to-treat analysis, median LOS (interquartile range) of HS and NS groups was 2.1 (1.2-4.6) vs 2.1 days (1.2-3.8), respectively, P = .73. We confirmed findings with per-protocol analysis, HS and NS groups with 2.0 (1.3-3.3) and 2.0 days (1.2-3.0), respectively, P = .96. Seven-day readmission rate for HS and NS groups were 4.3% and 3.1%, respectively, P = .77. Clinical worsening events were similar between groups (9% vs 8%, P = .97).CONCLUSIONS: Among infants admitted to the hospital with bronchiolitis, treatment with nebulized 3% HS compared with NS had no difference in LOS or 7-day readmission rates.WHAT'S KNOWN ON THIS SUBJECT: Bronchiolitis, the most frequent reason for hospitalization for infants younger than 1 year of age, has no proven treatments beyond supportive care. Although early studies suggested a potential benefit from 3% hypertonic saline, more recent studies have conflicting results. WHAT THIS STUDY ADDS:This prospective, randomized, double-blind, controlled trial in infants admitted with bronchiolitis (including patients with a history of previous wheeze) demonstrated no difference in length of stay between those who received hypertonic saline or normal saline without bronchodilators.

Though variability exists regarding program length, clinical composition, and nonclinical offerings, several common themes emerged that may help inform the development of a standard curriculum for use across all programs. This information provides a useful starting point if pediatric hospital medicine obtains formal subspecialty status. Journal of Hospital Medicine 2016;11:324-328. © 2016 Society of Hospital Medicine.

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Introduction: Teaching the pediatric physical exam (PE) is commonly reserved for pediatric clerkships. However, with the trend toward aligning basic science curricula with clinical skills development, teaching the pediatric PE as a variation of the adult PE supports integrated learning. Methods: This 2-hour infant and toddler examination workshop teaches the pediatric PE to 12-14 preclerkship medical students within a physical diagnosis course. Differences between the adult and the infant and toddler PE are made explicit, particularly regarding approach, sequence, and variations of the PE unique to infants and toddlers. Infants and toddlers are recruited from within the medical school community and serve as real subjects. Faculty examine one infant and one toddler in an interactive format, providing students the opportunity to learn the unique aspects of the pediatric PE and compare differences in growth and development. Results: A retrospective pre-/postsurvey conducted after the workshop revealed that students' perception of their skill levels increased, specifically their approach to the pediatric PE, use of observation as an important examination modality, identification of unique pediatric PE components, performance of a developmental assessment, and interpretation of growth charts on all items. Discussion: Our workshop's focus on teaching the pediatric PE to preclerkship students, ability to accommodate an entire class in a half-day session in a small-group interactive manner, and presence of actual infants and toddlers make it a distinctive contribution to the literature.