Nebulized Hypertonic Saline in the Treatment of Viral Bronchiolitis in Infants

Kuzik, Brian A.; Qadhi, Samim A. Al; Kent, S.; Flavin, Michael P.; Hopman, Wilma; Hotte, Simon; Gander, Sarah

doi:10.1016/j.jpeds.2007.04.010

Cited by 143 publications

(192 citation statements)

References 39 publications

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“…Our data confirm previous evidence (8-10, 14) revised in recent reviews on the effectiveness of nebulized HS as treatment for bronchiolitis in infants (15,16). Four trials involving 254 infants were considered (8)(9)(10)14), showing that nebulized 3% HS effectively determined a shorter mean length of (15,16). The findings on the clinical scores were more relevant among outpatients than inpatients, probably due to the reduced severity of the disease.…”

Section: Discussionsupporting

confidence: 88%

Effectiveness of Nebulized Hypertonic Saline and Epinephrine in Hospitalized Infants with Bronchiolitis

Giudice

Saitta²,

Leonardi

et al. 2012

Int J Immunopathol Pharmacol

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The objective of the study is to verify effects of nebulized 3% saline hypertonic solution (HS) in comparison to normal saline (NS) in addition to epinephrine in hospitalized children with bronchiolitis. Infants were randomly assigned either to receive every 6 hours nebulized NS (group I) or 3% HS (group II) in addition to epinephrine (1.5 mg) and to conventional treatment. The main endpoints of this study were the length of stay (LOS) in hospital and the clinical response score (CSS). Patients presented a significant decrease in CSS from the first through the third day of treatment, present in the first group but even more evident in the second group (p=0.0001). Comparison between group I and II data shows significant decrease in CSS in the 3% HS-treated patients both at the second (p<0.005) and at the third day of treatment (p<0.005). Infants in the NS control group had a mean LOS of 5.6±1.6 days, whereas children treated with 3% HS were discharged with a LOS of 4.9±1.3 days, reaching a significant decrease in stay (p<0.05). In hospitalized patients bronchiolitis nebulized 3% HS and epinephrine significantly decreased symptoms and LOS as compared to 0.9% NS and epinephrine.

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Section: Discussionsupporting

confidence: 88%

Effectiveness of Nebulized Hypertonic Saline and Epinephrine in Hospitalized Infants with Bronchiolitis

Giudice

Saitta²,

Leonardi

et al. 2012

Int J Immunopathol Pharmacol

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“…9,[11][12][13][14] Our results challenge the conclusions of the most recent Cochrane review of HS, 18 which suggests a potential benefit of HS. We believe this is partly attributed to the 2 to 3 times longer average LOS in the latter studies 9,[11][12][13][14] than in the studies in the United States and India. It is possible that HS has a greater effect when administered over a longer period of time than in an acute setting with a shorter LOS.…”

Section: Discussioncontrasting

confidence: 79%

“…[15][16][17] Initial studies using HS for infants hospitalized with bronchiolitis suggest decreased LOS and improved severity scores. [9][10][11][12][13][14] Those studies differed from this study by excluding infants with previous wheeze, administering study medications with bronchodilators, or study subjects having much longer mean LOS. 9,10,13,14 A 2013 Cochrane review of HS in bronchiolitis referencing the aforementioned studies suggested 3% HS given with bronchodilators may be considered a safe and effective treatment of infants with mild to moderate bronchiolitis.…”

Section: What This Study Addsmentioning

confidence: 99%

3% Hypertonic Saline Versus Normal Saline in Inpatient Bronchiolitis: A Randomized Controlled Trial

Silver¹,

Esteban-Cruciani²,

Azzarone³

et al. 2015

Pediatrics

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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.

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“…This hypothesis is supported by inpatient studies that showed a decrease in either severity scores and/or hospital length of stay when HS was given more frequently from admission until discharge. 6,11,16 However, in both inpatient and outpatient studies, an improvement in clinical scores was observed by study day 1. 15,16,20 Moreover, because bronchiolitis tends to be a selflimiting illness, we felt that any improvement noted after 24 hours of supportive care might reflect the natural course of disease.…”

Section: Discussionmentioning

confidence: 95%

“…7 Since this review, additional studies have evaluated HS in infants with bronchiolitis: 1 in an ambulatory setting, 3 in an emergency department (ED), and 5 in hospitalized patients. 6,[8][9][10][11][12][13][14][15][16] All of these studies have shown a reduction in pulmonary severity scores and/or a trend toward reduced admission rates in the HS group. Of note, all investigations to date have shown HS to be safe, with no patients experiencing decreased oxygen saturation, apnea, or cyanosis after administration of the medication.…”

Section: Discussionmentioning

confidence: 99%

7% Hypertonic Saline in Acute Bronchiolitis: A Randomized Controlled Trial

Jacobs

Foster²,

Wan

et al. 2014

Pediatrics

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BACKGROUND: Research suggests that hypertonic saline (HS) may improve mucous flow in infants with acute bronchiolitis. Data suggest a trend favoring reduced length of hospital stay and improved pulmonary scores with increasing concentration of nebulized solution to 3% and 5% saline as compared with 0.9% saline mixed with epinephrine. To our knowledge, 7% HS has not been previously investigated. METHODS: We conducted a prospective, double-blind, randomized controlled trial in 101 infants presenting with moderate to severe acute bronchiolitis. Subjects received either 7% saline or 0.9% saline, both with epinephrine. Our primary outcome was a change in bronchiolitis severity score (BSS), obtained before and after treatment, and at the time of disposition from the emergency department (ED). Secondary outcomes measured were hospitalization rate, proportion of admitted patients discharged at 23 hours, and ED and inpatient length of stay. RESULTS: At baseline, study groups were similar in demographic and clinical characteristics. The decrease in mean BSS was not statistically significant between groups (2.6 vs 2.4 for HS and control groups, respectively). The difference between the groups in proportion of admitted patients (42% in HS versus 49% in normal saline), ED or inpatient length of stay, and proportion of admitted patients discharged at 23 hours was not statistically significant. CONCLUSIONS: In moderate to severe acute bronchiolitis, inhalation of 7% HS with epinephrine does not appear to confer any clinically significant decrease in BSS when compared with 0.9% saline with epinephrine.

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Nebulized Hypertonic Saline in the Treatment of Viral Bronchiolitis in Infants

Cited by 143 publications

References 39 publications

Effectiveness of Nebulized Hypertonic Saline and Epinephrine in Hospitalized Infants with Bronchiolitis

Effectiveness of Nebulized Hypertonic Saline and Epinephrine in Hospitalized Infants with Bronchiolitis

3% Hypertonic Saline Versus Normal Saline in Inpatient Bronchiolitis: A Randomized Controlled Trial

7% Hypertonic Saline in Acute Bronchiolitis: A Randomized Controlled Trial

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