Does Nebulized Hypertonic Saline Improve Pediatric Bronchiolitis ?

Susan Wu MD Division of Hospital Medicine, Children's Hospital Los Angeles Assistant Professor of Clinical Pediatrics, Keck School of Medicine of the University of Southern CaliforniaMedicalResearch.com Interview with:
Susan Wu MD
Division of Hospital Medicine, Children’s Hospital Los Angeles
Assistant Professor of Clinical Pediatrics, Keck School of Medicine of the University of Southern California


MedicalResearch: What are the main findings of the study?

Dr. Wu: We performed a randomized trial at 2 urban free-standing children’s hospitals, comparing inhaled 3% hypertonic saline to 0.9% normal saline in patients under 24 months with bronchiolitis. Patients with prematurity less than 34 weeks, cyanotic heart disease, chronic pulmonary disease, and previous episodes of wheezing or bronchodilator use were excluded. Patients were 4 mL of study medication nebulized up to 3 times in the emergency department; if admitted, patients continued to receive the assigned study medication three times a day until discharge. A total of 408 patients were analyzed. We found that 28.9% of patients treated with hypertonic saline required hospital admission, compared with 42.6% of patients in the normal saline group.

MedicalResearch: Were any of the findings unexpected?

Dr. Wu: We did not find any difference in length of stay between groups, which is contrary to previous studies comparing hypertonic saline and normal saline. However, the number of patients requiring admission in our study was underpowered to detect small differences in length of stay. We also suspect that patients who responded well to therapy may have been discharged, thus biasing our inpatient sample to those whom the treatment did not help.

MedicalResearch: What should clinicians and patients take away from your report?

Dr. Wu: Treating bronchiolitis patients with nebulized hypertonic saline in the emergency department may prevent hospital admission.

MedicalResearch: What recommendations do you have for future research as a result of this study?

Dr. Wu: More studies need to be done to evaluate the optimal concentration and dosing interval to maximize benefit. In addition, our study pre-treated every study medication dose with albuterol; future studies should evaluate the efficacy of hypertonic saline in the emergency department setting without concomitant bronchodilator.

Citation:

Nebulized hypertonic saline for bronchiolitis: a randomized clinical trial
JAMA Pediatrics

Wu S, Baker C, Lang ME, et al. Nebulized Hypertonic Saline for Bronchiolitis: A Randomized Clinical Trial. JAMA Pediatr. Published online May 26, 2014. doi:10.1001/jamapediatrics.2014.301.