Seven percent hypertonic saline—0.1% hyaluronic acid in infants with mild‐to‐moderate bronchiolitis

Nenna, Raffaella; Papoff, Paola; Moretti, Corrado; Angelis, Daniela De; Battaglia, Massimo; Papasso, Stefano; Bernabucci, Mariangela; Cangiano, Giulia; Petrarca, Laura; Salvadei, Serena; Nicolai, Ambra; Ferrara, Marianna; Bonci, Enea

doi:10.1002/ppul.22935

Cited by 20 publications

(27 citation statements)

References 28 publications

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“…In 7 additional trials not included in the review by Zhang et al 49 there was no difference between saline preparations in terms of LOS. 31,40,42,47 This was also reported by Florin et al 48 in their 2015 publication. This may reflect a benefit from any saline intervention, whether hypertonic or NS, since no comparison was made to patients who were not placed on a saline preparation.…”

Section: Discussion/conclusionsupporting

confidence: 72%

“…Delayed efficacy was likely due to edema, inflammation, and mucus plugs of the bronchiolar epithelium in bronchiolitis, which may require exposure to multiple doses of saline over a longer period of time. The studies had various limitations; the most common was that, with the exception of 4 trials, 34,35,42,46 a bronchodilator or vasoconstrictor /bronchodilator, and in one instance HA, were used in both arms of the studies, the active and control groups.…”

Section: Discussion/conclusionmentioning

confidence: 99%

“…In another 2014 study, Nenna et al 42 conducted a prospective, randomized, double-blind, controlled study to evaluate the efficacy of 2.5 mL of 7% hypertonic saline with 0.1% hyaluronic acid vs 2.5 mL of NS in infants <7 months of age who were hospitalized with mild to moderate bronchiolitis. Primary outcome was hospital LOS, while secondary outcomes included safety and reduction in the bronchiolitis severity score.…”

Section: Clinical Trials Evaluating Hypertonic Saline Use In Hospitalsmentioning

confidence: 99%

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Hypertonic Saline for the Treatment of Bronchiolitis in Infants and Young Children: A Critical Review of the Literature

Baron

El-Chaar

2016

The Journal of Pediatric Pharmacology and Therapeutics

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Bronchiolitis, an infection of the lower respiratory tract, is the leading cause of infant and child hospitalization in the United States. Therapeutic options for management of bronchiolitis are limited. Hypertonic saline inhalation therapy has been studied in numerous clinical trials with mixed results. In 2014, the American Academy of Pediatrics (AAP) published updated guidelines on the diagnosis and management of bronchiolitis, which include new recommendations on the use of hypertonic saline. We reviewed all published clinical trials mentioned in the 2014 AAP guidelines, as well as additional trials published since the guidelines, and critically evaluated each trial to determine efficacy, safety, and expectations of hypertonic saline inhalation therapy. A total of 2682 infants were studied over the course of 22 clinical trials. Nine trials were carried out in the outpatient/clinic/emergency department and 13 in the inpatient setting. We agree with the AAP guidelines regarding the recommendation to use nebulized hypertonic saline for infants hospitalized with bronchiolitis, with the expectation of reducing bronchiolitis scores and length of stay when it is expected to last more than 72 hours. However, we also believe there might be an advantage for hypertonic saline in reducing admission rates from the emergency department, based on close examination of the results of recent trials. This review also highlights important gaps in the available literature that need to be addressed in order to define the role of inhaled hypertonic saline therapy.INDEX TERMS: bronchiolitis, hypertonic saline, infants, pediatrics, review J Pediatr Pharmacol Ther 2016;21(1):7-26

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Section: Discussion/conclusionsupporting

confidence: 72%

Section: Discussion/conclusionmentioning

confidence: 99%

Section: Clinical Trials Evaluating Hypertonic Saline Use In Hospitalsmentioning

confidence: 99%

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Hypertonic Saline for the Treatment of Bronchiolitis in Infants and Young Children: A Critical Review of the Literature

Baron

El-Chaar

2016

The Journal of Pediatric Pharmacology and Therapeutics

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“…In a recent study Nenna et al (19) treated 39 bronchiolitis either by 7% HS plus hyaluronic acid or 0.9 saline. They administered 2.5 cc 7% HS twice a day for three days.…”

Section: Discussionmentioning

confidence: 99%

“…In the light of cystic fibrosis studies, it was shown that 7% HS increases mucociliary clearance and decreases epithelial edema (15)(16)(17). Thus, recently 7% HS has been studied in infants with bronchiolitis (18,19). But the effect of 7 % HS treatment to the bronchiolitis outcome is still dilemma.…”

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confidence: 99%

Comparing the Efficacy of 7%, 3% and 0.9% Saline in Moderate to Severe Bronchiolitis in Infants

et al. 2016

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Background:There is no standard treatment option in acute bronchiolitis. 3-7% hypertonic saline (HS) seems to be the effective treatment choice for reducing the hospitalization day. Aims: To compare the effect of nebulized 7% HS/ salbutamol and 3% HS/salbutamol to 0.9% saline/ salbutamol. The primary outcome measure was the effect of study drugs on the length of hospital stay (LOS). Secondary outcome measures were safety and efficacy in reducing the clinical severity score (CSS) at the 24 hours of the study. Study Design: Prospective, double-blinded randomized clinical study. Methods: The study consists of 104 infants. Groups were constituted according to the treatment they received: These are, group A -0.9% saline/salbutamol, group B -3% HS/salbutamol and group C-7% HS/salbutamol. Heart beat, Bronchiolitis CSS and oxygen saturation of the patients were determined before and after nebulization. The patients were monitored for adverse reactions. Results: Length of hospital stay in group A, B and C were as follows; 72.0 (20-288) hours in group A, 64.0 (12-168) hours in group B and 60.0 (12-264) hours in group C. No significant differences was observed among three groups (p>0.05). Conclusion: 7% HS and 3% HS does not have any effect to decrease LOS for infants with bronchiolitis. Keywords: Bronchiolitis, hypertonic saline, infant Copyright 2016 © Trakya University Faculty of Medicine Balkan Med J 201633:193-7 Comparing Bronchiolitis is the most frequent viral lower respiratory tract infection seen in infancy period characterized by cough, wheezing and tachypnea. Bronchiolitis is the major reason of infant hospitalization in both developed and developing countries. Although it is common there is no current standard treatment. Supportive care is the only evidence based treatment option (1,2). Many studies focused on testing the effects of bronchodilators such as β2-agonsits (3), epinephrine (4), glucocorticoids (5) and magnesium sulfate (6) with controversial results.There exists the first necrosis of the respiratory epithelium in bronchiolitis. Following by the fact that, exaggerated mucus production occurs due to the proliferation of goblet cells. On the other hand epithelial regeneration with nonciliated cells happens thus decreasing mucociliary clearance. Lymphocytic infiltration may result in submucosal edema (7). Johnson et al. (7) demonstrated that, airway obstruction in bronchiolitis was because of epithelial and inflammatory cell debris. And they did not observe bronchial smooth muscle constriction. This can explain why bronchodilator therapy is not effective in bronchiolitis. Thus the ideal treatment has to decrease submucosal edema and improve mucociliary clearance by restoring the elasticity and viscosity of the mucus. In the last decade, 3% and 5% hypertonic saline (HS) studied in infants with bronchiolitis with good results (8)(9)(10)(11)(12)(13)(14). In the light of cystic fibrosis studies, it was shown that 7% HS increases mucociliary clearance and decreases epithelial edema (15-17). Thus,

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Nebulised hypertonic saline solution for acute bronchiolitis in infants

Zhang

Mendoza-Sassi

Wainwright

et al. 2017

Cochrane Database of Systematic Reviews

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Seven percent hypertonic saline—0.1% hyaluronic acid in infants with mild‐to‐moderate bronchiolitis

Abstract: 7% HS-HA is a safe and effective therapy in treating infants hospitalized for mild-to-moderate bronchiolitis.

Cited by 20 publications

References 28 publications

Hypertonic Saline for the Treatment of Bronchiolitis in Infants and Young Children: A Critical Review of the Literature

Hypertonic Saline for the Treatment of Bronchiolitis in Infants and Young Children: A Critical Review of the Literature

Comparing the Efficacy of 7%, 3% and 0.9% Saline in Moderate to Severe Bronchiolitis in Infants

Nebulised hypertonic saline solution for acute bronchiolitis in infants

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