Aerosolised hypertonic saline in hospitalized young children with acute bronchiolitis: a randomized controlled clinical trial.

K B Maheshkumar, B P Karunakara, Manjunath Mallikarjuna Nagalli, H B Mallikarjuna
4.317 976


Objectives: To determine the effectiveness of aerosolised 3% saline in hospitalised children with acute bronchiolitis.
Design: Prospective, randomized, double blinded clinical study.
Setting: Referral teaching hospital, from October 2007 to March 2009.
Patients: 40 children [age less than 2 yrs] were enrolled sequentially and randomized into 2 groups [20 each; Group- A - 3% saline and Group-B [Normal saline].
Intervention: 4 nebulizations [3% saline or normal saline] were given every day until discharge. Additional inhalations were recorded as add-on nebulisations. Severity was assessed using the clinical severity score daily. Children showing worsening of clinical scores {treatment failure} were dropped from the study.
Principal outcome measures: Reduction in clinical severity & the length of hospital stay. Minor outcome measures studied were number of add-on nebulisations required & treatment failure.
Results: The reduction in clinical severity scores was 1.8±0.83 in the 3% saline group and 1.7±0.86 in the normal saline group. The length of hospital stay was 2.25±0.89 days in 3% saline group compared to 2.88±1.76 days in the normal saline group. The number of add-on nebulisation was 2.4±4.1 in the normal saline group and 1.7±1.75 in the 3% saline group. These observations were not statistically significant. A significant difference was found in terms of treatment failures between the 2 groups [4 Vs 0] [p=0.03].
Conclusions: In hospitalized children with moderate acute bronchiolitis, aerosolized 3% saline is safe and prevented worsening of clinical symptoms but is not superior to normal saline in reducing the clinical severity and the length of hospital stay.
Key words: hypertonic saline; viral bronchiolitis.
Abbreviations: NS- normal saline; 3S- 3% saline; LOS- length of hospital stay.


hypertonic saline; viral bronchiolitis.

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Gadomski AM, Bhasale AL. Bronchodilators for bronchiolitis. Cochrane Database of Syst Rev 2006, Issue Art No.: CD001266.

Patel H, Platt R, Lozano JM, Wang EEL. Glucocorticoids for actue viral bronchiolitis in infants and young children. Cochrane Database of Syst Rev 2004, Issue 3. Art No.: CD004878.

Mandelberg A, Tal G, Witzling M, Someck E, Houri S, Balin A, et al. Nebulized 3% hypertonic saline solution treatment in hospitalized infants with viral bronchiolitis. Chest 2003;123:481–7.

Sarrell EM, Tal G, Witzling M, Someck E, Houri S, Cohen HA, et al. Nebulized 3% hypertonic saline solution treatment in ambulatory children with viral bronchiolitis decreases symptoms. Chest 2002; 122: 2015–20.

Wang EE, Milner RA, Navas L, Maj H. Observer agreement for respiratory signs and oximetry in infants hospitalized with lower respiratory infections. Am Rev of Resp Dis 1992; 145(1):106–9. Law BJ, Langley JM, Allen U, Paes B, Lee D, Mitchell I, et al. The pediatric investigators collaborative network on infections in Canada study of predictors of hospitalization for respiratory syncytial virus infection for infants born at 33 through 35 completed weeks of gestation. Pediatr Infect Dis J 2004; 23: 806–814.

Tal G, Cesar K, Oron A, Houri S, Ballin A, Mandelberg A. Hypertonic saline/ epinephrine treatment in hospitalized infants with viral bronchiolitis reduces hospitalization stay: 2 years experience. IMAJ 2006; 8: 169–73.

Kuzik BA, Al Qadhi SA, Kent S, Flavin MP, Hopman W, Hotte S, et al. Nebulized hypertonic saline in the treatment of bronchiolitis in infants. J Pediatr 2007; 151: 266-70.

Zhang L, Mendoza-Sassi RA, Wainwright C, Klassen TP. Nebulized hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database of Syst Rev 2008, Issue 4. Art. No.: CD006458.