Hypertonic Saline for Bronchiolitis

Nebulized hypertonic saline reduced hospital length of stay in young children with bronchiolitis.


Viral bronchiolitis is a common cause of hospitalization for infants and young children during the winter months, but evidence does not support therapeutic interventions other than supportive care (Journal Watch Pediatrics and Adolescent Medicine Jan 10 2007). Nebulized hypertonic saline (HS) has shown promise in the treatment of small airway obstruction in patients with cystic fibrosis. To evaluate the efficacy of this treatment for viral bronchiolitis, investigators in Canada and the United Arab Emirates randomized 96 children younger than 18 months (mean age, 4.7 months) who were hospitalized with moderately severe bronc hiolitis to receive frequent (every 2–6 hours) doses of either nebulized 3.0% HS or 0.9% normal saline (NS).

Hospital length of stay, the primary outcome, was significantly shorter in the HS group than in the NS group (2.6 vs. 3.5 days). Discharge decisions were based on clinical judgment or protocol-based criteria at the treating clinician’s discretion. The frequency of add-on nonprotocol treatments, given at the attending physician’s discretion, was similar in the two groups; about 60% of nebulizations in both groups included albuterol or racemic epinephrine. No adverse respiratory effects were noted, although two children in the HS group and three in the NS group were withdrawn from the study by parents because of crying or agitation during nebulization.

Comment: Most of the hospitalized infants in this study tested positive for respiratory syncytial virus. Thus, these findings are applicable to typical moderately ill infants with bronchiolitis in the U.S. The nebulization treatments in this study were frequent, every 2 hours at first, but a previous inpatient study that administered nebulizations three times daily reported a similar 1-day reduction in hospital stay. Because most patients in the current study received additional nebulized medications rather than hypertonic saline alone, editorialists propose a future study to explore the possible synergy between HS and bronchodilators.

— Cornelius W. Van Niel, MD

Published in Journal Watch Pediatrics and Adolescent Medicine November 7, 2007

Citation(s):

Kuzik BA et al. Nebulized hypertonic saline in the treatment of viral bronchiolitis in infants. J Pediatr 2007 Sep; 151:266.

Medline abstract (Free)

Calogero C and Sly PD. Acute viral bronchiolitis: To treat or not to treat — That is the question. J Pediatr 2007 Sep; 151:235.