Outcome of treatment with nebulized 3% hypertonic saline solution in infants hospitalized with moderate bronchiolitis

Abstract

Bronchiolitis is the most common lower respiratory infectious disease in infants presenting with cough and/or wheeze and occurs most frequently in the winter months. Treatment of bronchiolitis by means of nebulization with inhaled corticosteroids and bronchodilator such as salbutamol or ipratropium bromide considered an effective method. Usually, 0.9% normal saline used together with the medications mentioned above. However, there are studies showing that 3% hypertonic saline might be a better choice compared with the normal saline. Objective: Our main aim of this study is to determine the improvement of patient’s condition by comparing the length of hospital stay and improvement in clinical severity score (CS score) in infants with moderate bronchiolitis nebulized with 3% hypertonic saline or 0.9% saline. Methods: 124 patients were arranged randomly to nebulize either 3% hypertonic saline with salbutamol plus budesonide (Group 1) or 0.9% saline with salbutamol plus budesonide (Group 2) three times per day until conditions were stable enough for discharge (with a CS score below 3). We recorded the SC scores of each patient before and after the first nebulization every day. Outcomes, considered mainly as ①differences in the length of hospital stay from admission to time taken to reach CS score < 3; ②the change in CS score after the first nebulization every day. A P value <0.05 was considered statistically significant. Results: 124 patients of them completed the study. Their mean age was 6.92±0.24 months (range, 3 to 12 months). The cases were diagnosed as moderate bronchiolitis with CS scores varying from 6 to 9. The mean length of hospital stay from admission to time taken to reach CS score <3 was 4.83 ±0.077 days for the whole subjects investigated, and it differed significantly between the two groups: 4.27±0.90 days in Group 1 and 5.39±0.610 days in Group 2. On the first day of treatment, the mean CS scores at baseline were 7.34±0.1 and 7.39±0.99 for Group 1 and Group 2, respectively. After the first nebulization, the CS scores decreased to 5.94±0.89 (SD-0.698) and 6.50±0.094 (SD 0.741) of Group 1 and Group 2, respectively. The P value in both groups were less than 0.001, indicating statistically differences between CS scores before and after nebulization by both groups of solutions in the treatment of moderate bronchiolitis. However, the differences of the mean values and standard deviation (SD) results after nebulization in the two groups suggested a better treatment outcome of 3% hypertonic saline with salbutamol plus budesonide than 0.9% normal saline. There were no significant differences between the respiratory rate, heart rate, saturation and add-on therapy in the two groups. No adverse events noted in both groups. Conclusion: The curative effect of 3% hypertonic saline group was significant better in comparison with the 0.9% normal saline group in terms of the improvement of CS score and length of hospital stay. In conclusion, 3% hypertonic saline is safe and effective in infants with moderate bronchiolitis.