Infants hospitalized with bronchiolitis saw no difference in length of stay or 7-day readmission rates when treated with nebulized 3% hypertonic saline (HS) compared with nebulized normal saline (NS), according to randomized, controlled study of 227 infants younger than aged 12 months when admitted with a diagnosis of bronchiolitis. Patients received either 4 mL nebulized 3% HS (113 infants) or 4 mL 0.9% NS (114 infants) every 4 hours from enrollment until hospital discharge. Researchers found:

• Median length of stay of HS and NS groups was 2.1 days vs 2.1 days, respectively.

• 7-day readmission rates for HS and NS groups were 4.3% vs 3.1%, respectively.

• Clinical worsening events were similar between groups.

Citation: Silver AH, Esteban-Cruciani N, Azzarone G, et al. 3% hypertonic saline versus normal saline in inpatient bronchiolitis: A randomized controlled trial. [Published online ahead of print November 9, 2015]. Pediatrics. doi: 10.1542/peds.2015-1037.

Commentary: Bronchiolitis, the most common lower respiratory tract infection in infants, is usually due to a viral infection, most often RSV, and can cause disease that ranges in severity from mild to life-threatening. Infants with bronchiolitis typically present with rhinitis, tachypnea, wheezing, and cough as well as occasionally crackles, and the use of accessory muscles. While many medications are used, supportive care and monitoring are the mainstays of therapy. Maintaining pulse above 90% is important, using supplemental oxygen when needed to achieve this. Alpha-adrenergic and beta-adrenergic bronchodilators are often used, though the evidence suggests that they are not usually helpful but can be tried and continued if they appear to help. Systemic steroids are often used, but they too lack evidence of efficacy.¹ This study shows that hypertonic saline can now join the list of interventions used with evidence of a lack of efficacy. —Neil Skolnik, MD

1. Diagnosis and management of bronchiolitis. Subcommittee on diagnosis and management of bronchiolitis. Pediatrics 2006;118(4):1774-1793. doi:10.1542/peds.2006-2223.