Nebulised normal saline in moderate acute bronchiolitis and pneumonia in a low- to middle-income country: a randomised trial in Papua New Guinea

Abstract

ABSTRACT Background Acute lower respiratory tract infections are the commonest cause of hospitalisation in young children and supportive care remains the cornerstone of management. A randomised open trial was undertaken at the Port Moresby General Hospital Children’s Emergency Department (CED) to determine whether nebulised normal saline had beneficial effects. Methods Children <2 years of age presenting with a clinical diagnosis of moderate acute bronchiolitis or moderate pneumonia were randomised to receive standard care alone or with nebulised normal saline administered hourly. The outcomes were the difference in respiratory distress scores (RDS) and oxygen saturation between 0 and 4 hours, and admission rates. Results A total of 199 patients participated; 100 patients were randomised to normal saline and 99 to standard care. At 4 hours there was a significant difference in the change of the respiratory distress scores: mean RDS reduced by 3.41 (95% CI 3.0–3.8) in the normal saline group, and for the standard group, the RDS reduced by 1.96 (95% CI 1.5–2.4, p < 0.0001). In those receiving normal saline oxygen saturation measured by pulse oximetry (SpO2) increased by a mean of 7% (95% CI 6.0–7.9) to 90.7% at 4 hours. For those receiving standard care, the SpO2 increased by a mean of 4% (95% CI 2.8–5.2) to 87.5% at 4 hours (p < 0.001). Of 100 patients, 58 (58%) in the normal saline group and 24 of 99 (24.2%) in the standard arm were discharged from the Children’s Emergency Department (p < 0.001). Conclusions This study supports the use of nebulised normal saline in the treatment of moderate acute bronchiolitis or pneumonia in an emergency department setting in a low- to middle-income country. Abbreviations ALRI, acute lower respiratory infection; CED, Children’s Emergency Department; NaCl, sodium chloride; PMGH, Port Moresby General Hospital; PNG, Papua New Guinea; RDS, respiratory distress score; SpO2, oxygen saturation by pulse oximetry.