Ferhan ELMALI, Alper ÖZCAN, Feyza ESEN, Ali Fatih KISAARSLAN, Yasemin TORUN ALTUNER, Seçil KÖSE, Ahmet ŞEHRİYAROĞLU, Zehra KARDAŞ, Umut ALTUĞ, Esef KARAKUŞ, Ahmet ÖZDEMİR, Mehmet KÖSE

Comparing the Efficacy of 7%, 3% and 0.9% Saline in Moderate to Severe Bronchiolitis in Infants

Background: There is no standard treatment option in acute bronchiolitis. 3-7% hypertonic saline (HS) seems to be the effective treatment choice for reducing the hospitalization day. Aims: To compare the effect of nebulized 7% HS/ salbutamol and 3% HS/salbutamol to 0.9% saline/ salbutamol. The primary outcome measure was the effect of study drugs on the length of hospital stay (LOS). Secondary outcome measures were safety and efficacy in reducing the clinical severity score (CSS) at the 24 hours of the study. Study Design: Prospective, double-blinded randomized clinical study. Methods: The study consists of 104 infants. Groups were constituted according to the treatment they received: These are, group A - 0.9% saline/salbutamol, group B -3% HS/salbutamol and group C-7% HS/salbutamol. Heart beat, Bronchiolitis CSS and oxygen saturation of the patients were determined before and after nebulization. The patients were monitored for adverse reactions. Results: Length of hospital stay in group A, B and C were as follows; 72.0 (20-288) hours in group A, 64.0 (12-168) hours in group B and 60.0 (12-264) hours in group C. No significant differences was observed among three groups (p>0.05). Conclusion: 7% HS and 3% HS does not have any effect to decrease LOS for infants with bronchiolitis.

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Ralston SL, Lieberthal AS, Meissner HC, Alverson BK, Baley JE, Gadomski AM, et al; American Academy of Pediatrics. Clinical practice guideline: the diagnosis, management, and prevention of bronchiolitis. Pediatrics 2014;134:e1474-502. [CrossRef]
Zorc JJ, Hall CB. Bronchiolitis: recent evidence on diagnosis and management. Pediatrics 2010;125:342-9. [CrossRef]
Gadomski AM, Brower M. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev 2014;6:CD001266. [CrossRef]
Simşek-Kiper PO, Kiper N, Hasçelik G, Dolgun A, Yalçin E, Doğru-Ersöz D, et al. Emergency room management of acute bronchiolitis: a randomized trial of nebulized epinephrine. Turk J Pediatr 2011;53:651-60.
Fernandes RM, Bialy LM, Vandermeer B, Tjosvold L, Plint AC, Patel H, et al. Glucocorticoids for acute viral bronchiol- itis in infants and young children. Cochrane Database Syst Rev 2013;6:CD004878. [CrossRef]
Kose M, Ozturk MA, Poyrazoğlu H, Elmas T, Ekinci D, Tubas F, et al. The efficacy of nebulized salbutamol, magnesium sul- fate, and salbutamol/magnesium sulfate combination in moder- ate bronchiolitis. Eur J Pediatr 2014;173:1157-60. [CrossRef]
Johnson JE, Gonzales RA, Olson SJ, Wright PF, Graham BS. The histopathology of fatal untreated human respiratory syncy- tial virus infection. Mod Pathol 2007;20:108-19. [CrossRef]
Ipek IO, Yalcin EU, Sezer RG, Bozaykut A. The efficacy of neb- ulized salbutamol, hypertonic saline and salbutamol/hypertonic saline combination in moderate bronchiolitis. Pulm Pharmacol Ther 2011;24:633-7. [CrossRef]
Grewal S, Ali S, McConnell DW, Vandermeer B, Klassen TP. A randomized trial of nebulized 3% hypertonic saline with epi- nephrine in the treatment of acute bronchiolitis in the emergen- cy department. Arch Pediatr Adolesc Med 2009;163:1007-12. [CrossRef]
Kuzik BA, Al-Qadhi SA, Kent S, Flavin MP, Hopman W, Hotte S, et al. Nebulized hypertonic saline in the treatment of viral bronchiolitis in infants. J Pediatr 2007;151:266-70. [CrossRef]
Mandelberg A, Tal G, Witzling M, Someck E, Houri S, Balin A, et al. Nebulized 3% hypertonic saline solution treatment in hos- pitalized infants with viral bronchiolitis. Chest 2003;123:481-7. [CrossRef]
Sarrell EM, Tal G, Witzling M, Someck E, Houri S, Cohen HA, et al. Nebulized 3% hypertonic saline solution treatment in am- bulatory children with viral bronchiolitis decreases symptoms. Chest 2002;122:2015-20. [CrossRef]
Luo Z, Fu Z, Liu E, Xu X, Fu X, Peng D, et al. Nebulized hypertonic saline treatment in hospitalized children with moderate to severe viral bronchiolitis. Clin Microbiol Infect 2011;17:1829-33. [CrossRef]
Al-Ansari K, Sakran M, Davidson BL, El Sayyed R, Mahjoub H, Ibrahim K. Nebulized 5% or 3% hypertonic or 0.9% saline for treating acute bronchiolitis in infants. J Pediatr 2010;157:630-4. [CrossRef]
Tarran R, Grubb BR, Parsons D, Picher M, Hirsh AJ, Davis CW. The CF salt controversy: in vivo observations and therapeutic approaches. Mol Cell 2001;8:149-58. [CrossRef]
Robinson M, Hemming AL, Regnis JA, Wong AG, Bailey DL, Bautovich GJ, et al. Effect of increasing doses of hypertonic saline on mucociliary clearance in patients with cystic fibrosis. Thorax 1997;52:900-3. [CrossRef]
Mandelberg A, Amirav I. Hypertonic saline or high volume nor- mal saline for viral bronchiolitis: mechanisms and rationale. Pe- diatr Pulmonol 2010;45:36-40. [CrossRef]
Jacobs JD, Foster M, Wan J, Pershad J. 7% Hypertonic saline in acute bronchiolitis: a randomized controlled trial. Pediatrics 2014;133:e8-13. [CrossRef]
Nenna R, Papoff P, Moretti C, De Angelis D, Battaglia M, Pa- passo S, et al. Seven percent hypertonic saline--0.1% hyaluronic acid in infants with mild-to-moderate bronchiolitis. Pediatr Pul- monol 2014;49:919-25. [CrossRef]
Wang EE, Milner RA, Navas L, Maj H. Observer agreement for respiratory signs and oximetry in infants hospitalized with lower respiratory infections. Am Rev Respir Dis 1992;145:106-9. [CrossRef]
Zhang L, Mendoza-Sassi RA, Wainwright C, Klassen TP. Nebu- lised hypertonic saline solution for acute bronchiolitis in infants. Cochrane Database Syst Rev 2013;31;7:CD006458.
Everard ML, Hind D, Ugonna K, Freeman J, Bradburn M, Coo- per CL, et al. SABRE Study Team. SABRE: a multicentre ran- domised control trial of nebulised hypertonic saline in infants hospitalised with acute bronchiolitis. Thorax 2014;69:1105-12. [CrossRef]
Teunissen J, Hochs AH, Vaessen-Verberne A, Boehmer AL, Smeets CC, Brackel H, et al. The effect of 3% and 6% hyper- tonic saline in viral bronchiolitis: a randomised controlled trial. Eur Respir J 2014;44:913-21. [CrossRef]
Anil AB, Anil M, Saglam AB, Cetin N, Bal A, Aksu N. High volume normal saline alone is as effective as nebulized salbuta- mol-normal saline, epinephrine-normal saline, and 3% saline in mild bronchiolitis. Pediatr Pulmonol 2010;45:41-7. [CrossRef]
Sood N, Bennett WD, Zeman K, Brown J, Foy C, Boucher RC, et al. Increasing concentration of inhaled saline with or without amiloride: effect on mucociliary clearance in normal subjects. Am J Respir Crit Care Med 2003;167:158-63. [CrossRef]
Rosenfeld M, Davis S, Brumback L, Daniel S, Rowbotham R, Johnson R, et al. Inhaled hypertonic saline in infants and tod- dlers with cystic fibrosis: short-term tolerability, adherence, and safety. Pediatr Pulmonol 2011;46:666-71. [CrossRef]
Elkins MR, Robinson M, Rose BR, Harbour C, Moriarty CP, Marks GB, et al. National Hypertonic Saline in Cystic Fibrosis (NHSCF) Study Group. A controlled trial of long-term inhaled hypertonic saline in patients with cystic fibrosis. N Engl J Med 2006;354:229-40. [CrossRef]