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New Treatment for Bronchiolitis in Infants

Nebulized 3% saline in conjunction with bronchodilators shortened hospital stay and lowered clinical severity.

Current therapy for treating bronchiolitis in infants is only supportive; however, in several earlier studies, researchers have evaluated whether administering nebulized 3% saline might reduce severity and speed recovery. In a meta-analysis conducted by the Cochrane Collaboration, investigators analyzed four randomized, controlled trials (RCTs) that involved 189 inpatients and 65 outpatients (age, <24 months).

In three inpatient RCTs, infants assigned to 3% saline had a significantly shorter mean length of stay (by 1 day) than infants who received 0.9% normal saline. In two inpatient RCTs and the single outpatient trial, infants who received 3% saline, versus those who received 0.9% saline, had a significantly lower mean postinhalation clinical score during the first 3 days of treatment.

Comment: These results are encouraging, but some caveats should be noted. In three of the four trials, bronchodilators (epinephrine and terbutaline) were added to the 3% saline regimens. In the other trial, physicians could opt to add albuterol and racemic epinephrine (used in 37% and 23% of children, respectively). Because the total number of patients was small, no meaningful data about side effects are available. Nevertheless, 3% saline, when combined with a bronchodilator, does seem to shorten length of hospital stay in children who are admitted with diagnoses of bronchiolitis.

— Howard Bauchner, MD

Published in Journal Watch Pediatrics and Adolescent Medicine May 13, 2009

Citation(s):

Zhang L et al. Nebulized hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database Syst Rev 2008 Oct 8. (http://dx.doi.org/10.1002/14651858.CD006458.pub2)

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