Hypertonic (3%) saline vs 0.9% saline nebulization for acute viral Bronchiolitis: a randomized controlled trial at a tertiary centre in Chennai

Introduction: Lower respiratory tract infections are a common cause of hospitalisation in infants. It is estimated that infants younger than 12 months with bronchiolitis account for 18% of all paediatric admission , representing a great burden to industrialised healthcare systems each winter. Bronchiolitis is defined as the first respiratory tract infection in infants younger than 12 months. Clinically, it can be manifested by cough, tachypnoea, apnoea, increased respiratory effort, fever, nasal congestion and rhinorrhoea. On chest auscultation, the key feature is diffuse bilateral inspiratory crackles. The most common virus detected in children with bronchiolitis is respiratory syncytial virus (RSV). Aim of the Study: To compare the length of hospital stay (primary) and improvement in clinical severity scores (secondary) among children with bronchiolitis nebulized with 3 % hypertonic saline or 0.9% saline. Materials and Methods: It is a randomized, double-blind, controlled trial involving infants and children aged 1 to 24 months hospitalized with acute bronchiolitis of moderate severity. Nebulization of 4 ml of 3% hypertonic saline or 4 mL of 0.9% saline, along with 2.5 mg salbutamol, at 4-hourly intervals was done till the patient was ready for discharge. Monitoring parameters for improvement or worsening of the condition were measured and recorded at admission and then at 12 hourly intervals. Results: Baseline characteristics were similar in two groups. Median clinical severity score at admission was 6 (IQR-1) in both the groups. Clinical severity scores monitored afterwards 12-hourly till discharge (132 h) did not show statistically significant differences in 3% and 0.9% saline groups. Mean length of hospital stay (time to reach predefined clinical severity score<3) was 63.91 ± 22.46 h in 3% saline group and 63.54 ± 21.25 h in 0.9% saline group (P=0.878). No adverse events were reported by the parents, caregivers or treating medical attendants in both groups. Conclusion: Nebulized 3 % saline is not superior to 0.9% saline in infants with clinically diagnosed acute bronchiolitis.