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In a randomized, double-blind trial, investigators compared the efficacy and safety of adding 3%, 5%, or 0.9% (normal) saline solution to nebulized epinephrine for treatment of moderate-to-severe bronchiolitis in infants ≤18 months old who were admitted to a short-stay unit in Qatar. Infants were excluded if they were born at ≤34 weeks' gestation; had received steroids within 48 hours; or had oxygen saturation <85%, chronic lung or heart disease, immunodeficiency, obtundation, respiratory failure, or apnea.
Of 187 eligible infants (median age, 3.1 months), 171 received 1.5 mL of nebulized epinephrine mixed with 5 mL of 3%, 5%, or 0.9% saline solution at enrollment and every 4 hours thereafter. At 24 hours, mean bronchiolitis severity scores were not statistically different among the three treatment groups. At 48 hours, the mean severity score was significantly lower in the 5% saline group than in the normal saline group (3.69 vs. 4.12 on a 0–12-point scale); the mean score in the 3% saline group fell between the other scores (4.00). Mean length of stay was similar among groups (about 1.5 days). No patient required hospital admission, worsened after treatment, or was withdrawn because of apnea or cyanosis.
Al-Ansari K et al. Nebulized 5% or 3% hypertonic or 0.9% saline for treating acute bronchiolitis in infants. J Pediatr 2010 Oct; 157:630.
Comment
Although the difference in bronchiolitis severity scores between infants treated with 5% saline and normal saline was statistically significant, the difference is unlikely to be clinically meaningful. On this basis, I see little reason to use 3% or 5% saline rather than normal saline with epinephrine in infants with moderate-to-severe bronchiolitis.