Vol 7 | Issue 4 | April 2020 Indian J Child Health 144 Original Article Comparative efficacy of nebulization with 3% hypertonic saline and 0.9% normal saline in the management of acute bronchiolitis Sushmita Singh 1 , Rupesh Masand 2 , Girdhari Lal Sharma 3 , Swati Mehta 1 From 1 PG Resident, 2 Professor, 3 Assistant Professor, Department of Pediatrics, National Institute of Medical Sciences and Research, Jaipur, Rajasthan, India Correspondence to: Rupesh Masand, Sector - 1/H/193, Indira Gandhi Nagar, Jagatpura, Jaipur, Rajasthan, India. E-mail: masand.rupesh72@gmail.com Received - 26 February 2020 Initial Review - 15 March 2020 Accepted - 13 April 2020 B ronchiolitis refers to the inflammation of the bronchioles and is defined according to the AAP guidelines as a viral upper respiratory tract infection associated with respiratory distress and wheezing in children younger than 2 years of age [1]. Common viral causes of bronchiolitis include respiratory syncytial virus (RSV), parainfluenza virus, influenza, human metapneumovirus, and rhinovirus of which RSV accounts for approximately 60–75% of bronchiolitis cases [1]. The standard treatment comprises of sufficient humidified oxygen inhalation, fluid intake, and supportive care [2,3]. The review of recent literature has focused on new therapies such as 3% hypertonic saline (HS) for the treatment of bronchiolitis. It modifies mucociliary clearance in both normal and diseased lungs in patients with bronchiolitis [4-8]. The updated AAP guidelines support the use of 3% HS nebulization for infants and children hospitalized for bronchiolitis [1]. A recent Cochrane review suggested that it reduces the length of hospitalization and therefore has an enormous cost-saving potential, both in developing and developed countries [9]. Due to the paucity of therapeutic options for bronchiolitis and possibility of benefit by the usage of 3% HS, this study was conducted to compare the efficacy of 3% HS with 0.9% normal saline (NS) nebulization in the management of acute bronchiolitis. MATERIALS AND METHODS This randomized, double-blind, control study was conducted from January 2018 to June 2019 in the pediatric ward of a tertiary care teaching hospital in Jaipur, Rajasthan in acute bronchiolitis patients aged 1–24 months. Bronchiolitis of moderate severity was decided by clinical severity score (CSS) as described by Wang et al. [10]. A signed informed consent was obtained from the parents or guardians of the study subjects. Bronchiolitis was defined by first episode of wheezing along with prodrome of upper respiratory tract infection including rhinorrhea, cough, and sometimes low- grade fever, which may progress to dyspnea [11]. The primary outcome was to compare the improvement in CSS in the study subjects and secondary outcome was to compare the length of hospital stay (LOS) (time taken from admission till discharge). It was hypothesized that 3% HS is not superior to 0.9% NS nebulization in hospitalized children with bronchiolitis. Sample size was calculated using the formula: N=[(z1+z2) 2 (O1 2 +O2 2 )]/(U1-U2) 2 where N=sample size; z1 = confidence level; Ó1 & Ó2 = standard deviation of outcome variable (CSS) in the 1 st (HS) and 2 nd (NS) intervention group, respectively; and Û1 & Û2 = mean change in CSS among the 1 st (HS) and 2 nd (NS) intervention group, respectively. To have an ABSTRACT Background: There is a dearth of therapeutic modalities for the management of bronchiolitis in children. Objective: The objective of the study was to compare the improvement in clinical severity scores and the length of hospital stay (LOS) among children with bronchiolitis nebulized with either 3% hypertonic saline (HS) or 0.9% normal saline (NS). Materials and Methods: A total of 360 hospitalized patients of age 1–24 months, diagnosed as a case of acute bronchiolitis of moderate severity, were randomized to receive either 4 ml of 3% HS (Group A) or 4 ml of 0.9% NS (Group B) along with 1.5 mg of epinephrine in each arm, at 4 hourly intervals till the patients were ready for discharge. Appropriate statistical analysis was carried out using the collected data. Results: All the baseline characteristics were similar in both the groups. There was a significant (p=0.0011) reduction of 13 h (12.2%), i.e., from 4 days 23 h in Group B (NS) to 4 days 10 h in Group A in the mean LOS and significant difference (p=0.0001) in the clinical severity score was noted from the 2 nd day onward in Group A as compared to Group B. No adverse events were observed or reported by the treating medical team or the patients’ caregiver in both the study groups. Conclusion: Nebulization with 3% HS is superior to 0.9% NS nebulization in infants with clinically diagnosed acute bronchiolitis. Key words: Bronchiolitis, Hypertonic saline, Nebulization, Normal saline