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3% Hypertonic Saline for Bronchiolitis

Infants treated with hypertonic saline had outcomes similar to those treated with normal saline.

A recent Cochrane review suggested that 3% hypertonic saline might reduce length of stay in hospitalized infants with bronchiolitis (JW Pediatr Adolesc Med May 13 2009). In a randomized, double-blind clinical trial conducted at a single pediatric emergency department in Canada, 46 infants with bronchiolitis received nebulized racemic epinephrine with either 3% hypertonic saline or normal saline.

Two hours after treatment, no differences were noted between the groups in the two primary outcome measures — change in a reliable and valid measure of respiratory distress and change in oxygen saturation. Fewer infants in the hypertonic saline group than in the control group were admitted to the hospital, but this difference was not statistically significant (35% vs. 57%).

Comment: Bronchiolitis is one of the few pediatric conditions for which hospitalization rates have increased during the past 2 decades. These results will likely prolong the debate about the use of 3% hypertonic saline to treat bronchiolitis. However, in view of recent findings that the combination of nebulized epinephrine and corticosteroids reduces admission rates (JW Emerg Med May 13 2009), we might be on our way to developing effective treatments for bronchiolitis.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine November 25, 2009

Citation(s):

Grewal S et al. A randomized trial of nebulized 3% hypertonic saline with epinephrine in the treatment of acute bronchiolitis in the emergency department. Arch Pediatr Adolesc Med 2009 Nov; 163:1007.

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Review and add to remarks on this article

• hypertonic saline vs corticosteroid
  Joalie E Davie, New Mexico, 1 Dec 2009 1:03 PM EST
  Even thought the difference of 35% vs 53 % need for admission among the the hypertonic and normal saline groups... [more]

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