COMPARISON OF EFFICACY OF NEBULIZATION WITH EPINEPHRINE IN HYPERTONIC SALINE VERSUS PLACEBO IN HYPERTONIC SALINE FOR THE TREATMENT OF MODERATE BRONCHIOLITIS
Keywords:
Bronchiolitis, Epinephrine, Hospitalization, Hypertonic Saline Solution, Infant, Nebulizers and Vaporizers, Respiratory Syncytial Virus Infections.Abstract
Background: Bronchiolitis is one of the most prevalent lower respiratory tract infections among infants, primarily caused by respiratory syncytial virus (RSV). It is a leading cause of pediatric hospitalization during the first year of life, with an estimated hospitalization rate of 6.7%. Despite advancements in supportive care, no specific pharmacologic treatment has consistently demonstrated efficacy in reducing disease severity or hospital stay. This study evaluated the therapeutic effectiveness of nebulized epinephrine in 3% hypertonic saline compared to placebo in 3% hypertonic saline for moderate bronchiolitis.
Objective: To compare the efficacy of nebulization with epinephrine in 3% hypertonic saline versus placebo in 3% hypertonic saline in reducing hospital stay and improving clinical outcomes among infants with moderate bronchiolitis.
Methods: This single-blinded randomized controlled trial included 194 infants under 24 months admitted with clinically diagnosed moderate bronchiolitis to The Children’s Hospital and The University of Child Health Sciences, Lahore. Participants were randomly assigned into two equal groups of 97 infants each. Group A received nebulized epinephrine (3 ml of 1:1000 solution) in 3% hypertonic saline (7 ml), while Group B received placebo (3 ml sterile water) in 3% hypertonic saline (7 ml). Outcomes measured included length of hospital stay, respiratory rate, WDF score, oxygen saturation (SpO₂), and heart rate before and after treatment. Data were analyzed using SPSS version 26 with p ≤ 0.05 considered statistically significant.
Results: Infants treated with epinephrine in 3% hypertonic saline demonstrated a significantly shorter hospital stay (3.72 ± 0.45 days) compared to the placebo group (4.73 ± 0.45 days; p = 0.000). Marked improvements were observed in respiratory rate (32.64 ± 1.27 vs 33.35 ± 0.63; p = 0.006) and WDF score (2.52 ± 0.15 vs 2.87 ± 0.08; p = 0.000). Differences in oxygen saturation (p = 0.067) and heart rate (p = 0.119) were not statistically significant. No adverse effects were reported in either group.
Conclusion: Nebulized epinephrine in 3% hypertonic saline was more effective than placebo in improving clinical parameters and reducing hospital stay in infants with moderate bronchiolitis, with no observed side effects. The findings support its consideration as a safe and efficient therapeutic option in pediatric bronchiolitis management.
References
1. Alatwani, S. H.'Almusway, Z. M. & Alwaeli, S. H. H., 2021. Application of nebulized 3% hypertonic saline in comparison to conventional therapy for treatment of bronchiolitis and effective on hospital duration of patient. Curr Pediatr Res, 25(1093-8
2. Ali, A.'Naeem, H. M. M.'Rafique, A.'Hussain, S.'Rasheed, M. & Uzair, M., 2022. Comparison of Hypertonic Saline vs Salbutamol in Normal Saline Nebulization in Children with Bronchiolitis. Pakistan Journal of Medical & Health Sciences, 16(10): 796-796
3. Angurana, S. K.'Williams, V. & Takia, L., 2023. Acute viral bronchiolitis: A narrative review. Journal of Pediatric Intensive Care, 12(02): 079-086
4. Bakalović, G.'Jarkoč, T.'Begić, N.'Lepara, O.'Bokonjić, D.'Mihajlović, D.'Pasić, A. & Fajkić, A., 2023. Efficacy of nebulized hypertonic saline versus normal saline in the treatment of acute bronchiolitis in inpatient infants. Medicinski Glasnik, 20(2):
5. Dhal, S. S. & Sagar, H., 2022. Managing bronchiolitis in pediatric patients: Current evidence. Indian Journal of Respiratory Care¦ Volume, 11(4): 292
6. Elesh, H. & El-khaleegy, H., 2021. Efficacy of Nebulized Hypertonic Saline 3% in comparison to Nebulized Normal Saline 0.9% in Children with Acute Bronchiolitis. International Journal of Medical Arts, 3(3): 1584-1588
7. Elkhateeb, N. E. A. G.'Hamza, M. B.'El Shafiey, R. M. G. & Abdel-Razik, A. M., 2022. Assessment of the Efficacy of Nebulized 3% Hypertonic Saline versus Nebulized Adrenaline in Infants with Acute Bronchiolitis.
8. Elliott, S. A.'Gaudet, L. A.'Fernandes, R. M.'Vandermeer, B.'Freedman, S. B.'Johnson, D. W.'Plint, A. C.'Klassen, T. P.'Allain, D. & Hartling, L., 2021. Comparative efficacy of bronchiolitis interventions in acute care: a network meta-analysis. Pediatrics, 147(5):
9. Gohil, J. R.'Sheladiya, A. M.'Adithya, N. & Bhojak, R. D., 2022. Adrenaline and Dexamethasone, vs Adrenaline and Fluticasone, vs Adrenaline alone in Bronchiolitis: A Randomized Controlled Trial.
10. Hmar, L.'Brahmacharimayum, S.'Golmei, N.'Moirangthem, M. & Chongtham, S., 2020. Comparison of 3% saline versus normal saline as a diluent for nebulization in hospitalized children with acute bronchiolitis: a randomized clinical trial. Journal of Medical Society, 34(2): 86-90
11. Hossain, R. M.'Shams, S.'Kader, M.'Pervez, M.'Bhuiyan, M. F. H.'Hasan, M. M. & Mollah, M., 2022. Efficacy of nebulized hypertonic saline versus normal saline and salbutamol in treating acute bronchiolitis in a tertiary hospital: a randomized control trial. Int J Contemp Pediatr, 9(523-8
12. House, S. A.'Gadomski, A. M. & Ralston, S. L., 2020. Evaluating the placebo status of nebulized normal saline in patients with acute viral bronchiolitis: a systematic review and meta-analysis. JAMA pediatrics, 174(3): 250-259
13. Jaquet-Pilloud, R.'Verga, M.-E.'Russo, M.'Gehri, M. & Pauchard, J.-Y., 2020. Nebulised hypertonic saline in moderate-to-severe bronchiolitis: a randomised clinical trial. Archives of disease in childhood, 105(3): 236-240
14. Linssen, R. S.'Schechter, M. S. & Rubin, B. K., 2023. Bronchiolitis therapies and misadventures. Paediatric Respiratory Reviews, 46(49-56
15. Rocha, G., 2022. Inhaled pharmacotherapy for neonates: a narrative review. Turkish Archives of Pediatrics, 57(1): 5
16. Singh, S.'Masand, R.'Sharma, G. L. & Mehta, S., 2020. Comparative efficacy of nebulization with 3% hypertonic saline and 0.9% normal saline in the management of acute bronchiolitis. Indian Journal of Child Health, 7(4): 144-147
17. Štanfel, D.'Kalogjera, L.'Ryazantsev, S. V.'Hlača, K.'Radtsig, E. Y.'Teimuraz, R. & Hrabač, P., 2022. The role of seawater and saline solutions in treatment of upper respiratory conditions. Marine drugs, 20(5): 330
18. Yasin, F.'Afridi, Z. S.'Mahmood, Q.'Khan, A. A.'Condon, S. & Khan, R. A., 2021. Role of nebulized epinephrine in moderate bronchiolitis: a quasi-randomized trial. Irish Journal of Medical Science (1971-), 190(239-242
19. Schmidt, M. N.'Daugberg, R.'Nygaard, U.'Nielsen, X. C.'Chawes, B.'Rytter, M. H. & Schoos, A.-M. M., 2024. Normal saline for children with bronchiolitis: study protocol for a randomised controlled non-inferiority trial. BMJ Paediatrics Open, 8(1):
20. Mellick, L. B., 2024. The De-implementation of Bronchiolitis Medications: Is It Time for a Moratorium? Pediatric Emergency Care, 40(4): e30-e32
21. Meyburg, J. & Ries, M., 2020. Decision-making in acute viral bronchiolitis: a universal guideline and a publication gap. Plos one, 15(8): e0237801
22. Naveed, H.'Munir, S.'Rafiq, K.'Tayyab, A.'Naseer, N.'Hussain, I.'Halim, M. & Mumtaz, H., 2023. Comparison of nebulised 3% hypertonic saline with ipratropium bromide in treatment of children with bronchiolitis: a randomized control trial. Annals of Medicine and Surgery, 85(11): 5484-5490
23. Pamecha, P. & Mandot, S., 2021. A randomized controlled trial of nebulized epinephrine versus nebulized hypertonic saline in infants with acute bronchiolitis. International Journal of Contemporary Pediatrics, 8(7): 1176
24. Pandit, P.'Hoque, M.'Pandit, H.'Dhar, S.'Mondal, D. & Ahmad, F., 2022. Efficacy of Nebulized Hypertonic Saline (3%) Versus Normal Saline and Salbutamol in Treating Acute Bronchiolitis in A Tertiary Hospital: A Randomized Controlled Trial. Mymensingh Medical Journal: MMJ, 31(2): 295-303
25. Pereira, R. A.'Oliveira de Almeida, V.'Zambrano, M.'Zhang, L. & Amantéa, S. L., 2022. Effects of nebulized epinephrine in association with hypertonic saline for infants with acute bronchiolitis: A systematic review and meta‐analysis. Health Science Reports, 5(3): e598
26. Pérez, M. & Piedimonte, G., 2020. Bronchiolitis. Pediatric Respiratory Diseases: A Comprehensive Textbook, 283-298
27. Pukai, G. & Duke, T., 2020. Nebulised normal saline in moderate acute bronchiolitis and pneumonia in a low-to middle-income country: a randomised trial in Papua New Guinea. Paediatrics and International Child Health, 40(3): 171-176
Downloads
Published
Issue
Section
License
Copyright (c) 2023 Axis Journal of Medical and Biosocial Sciences
This work is licensed under a Creative Commons Attribution 4.0 International License.
