3% Hypertonic saline versus normal saline in inpatient bronchiolitis

A randomized controlled trial

Alyssa H. Silver, Nora Esteban-Cruciani, Gabriella C. Azzarone, Lindsey C. Douglas, Diana S. Lee, Sheila Liewehr, Joanne M. Nazif, Ilir Agalliu, Susan Villegas, Hai Jung Helen Rhim, Michael L. Rinke, Katherine M. O'Connor

Research output: Contribution to journalArticle

23 Citations (Scopus)

Abstract

BACKGROUND AND OBJECTIVES: Bronchiolitis, the most common reason for hospitalization in children younger than 1 year in the United States, has no proven therapies effective beyond supportive care. We aimed to investigate the effect of nebulized 3% hypertonic saline (HS) compared with nebulized normal saline (NS) on length of stay (LOS) in infants hospitalized with bronchiolitis. METHODS: We conducted a prospective, randomized, double-blind, controlled trial in an urban tertiary care children's hospital in 227 infants younger than 12 months old admitted with a diagnosis of bronchiolitis (190 completed the study); 113 infants were randomized to HS (93 completed the study), and 114 to NS (97 completed the study). Subjects received 4 mL nebulized 3% HS or 4 mL 0.9% NS every 4 hours from enrollment until hospital discharge. The primary outcome was median LOS. Secondary outcomes were total adverse events, subdivided as clinical worsening and readmissions. RESULTS: Patient characteristics were similar in groups. In intention-to-treat analysis, median LOS (interquartile range) of HS and NS groups was 2.1 (1.2-4.6) vs 2.1 days (1.2-3.8), respectively, P =.73. We confirmed findings with per-protocol analysis, HS and NS groups with 2.0 (1.3-3.3) and 2.0 days (1.2-3.0), respectively, P =.96. Seven-day readmission rate for HS and NS groups were 4.3% and 3.1%, respectively, P =.77. Clinical worsening events were similar between groups (9% vs 8%, P =.97). CONCLUSIONS: Among infants admitted to the hospital with bronchiolitis, treatment with nebulized 3% HS compared with NS had no difference in LOS or 7-day readmission rates.

Original languageEnglish (US)
Pages (from-to)1036-1043
Number of pages8
JournalPediatrics
Volume136
Issue number6
DOIs
StatePublished - Dec 1 2015

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Bronchiolitis
Inpatients
Length of Stay
Randomized Controlled Trials
Intention to Treat Analysis
Tertiary Healthcare
Hospitalization
Therapeutics

ASJC Scopus subject areas

  • Pediatrics, Perinatology, and Child Health

Cite this

3% Hypertonic saline versus normal saline in inpatient bronchiolitis : A randomized controlled trial. / Silver, Alyssa H.; Esteban-Cruciani, Nora; Azzarone, Gabriella C.; Douglas, Lindsey C.; Lee, Diana S.; Liewehr, Sheila; Nazif, Joanne M.; Agalliu, Ilir; Villegas, Susan; Rhim, Hai Jung Helen; Rinke, Michael L.; O'Connor, Katherine M.

In: Pediatrics, Vol. 136, No. 6, 01.12.2015, p. 1036-1043.

Research output: Contribution to journalArticle

Silver, Alyssa H. ; Esteban-Cruciani, Nora ; Azzarone, Gabriella C. ; Douglas, Lindsey C. ; Lee, Diana S. ; Liewehr, Sheila ; Nazif, Joanne M. ; Agalliu, Ilir ; Villegas, Susan ; Rhim, Hai Jung Helen ; Rinke, Michael L. ; O'Connor, Katherine M. / 3% Hypertonic saline versus normal saline in inpatient bronchiolitis : A randomized controlled trial. In: Pediatrics. 2015 ; Vol. 136, No. 6. pp. 1036-1043.
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abstract = "BACKGROUND AND OBJECTIVES: Bronchiolitis, the most common reason for hospitalization in children younger than 1 year in the United States, has no proven therapies effective beyond supportive care. We aimed to investigate the effect of nebulized 3{\%} hypertonic saline (HS) compared with nebulized normal saline (NS) on length of stay (LOS) in infants hospitalized with bronchiolitis. METHODS: We conducted a prospective, randomized, double-blind, controlled trial in an urban tertiary care children's hospital in 227 infants younger than 12 months old admitted with a diagnosis of bronchiolitis (190 completed the study); 113 infants were randomized to HS (93 completed the study), and 114 to NS (97 completed the study). Subjects received 4 mL nebulized 3{\%} HS or 4 mL 0.9{\%} NS every 4 hours from enrollment until hospital discharge. The primary outcome was median LOS. Secondary outcomes were total adverse events, subdivided as clinical worsening and readmissions. RESULTS: Patient characteristics were similar in groups. In intention-to-treat analysis, median LOS (interquartile range) of HS and NS groups was 2.1 (1.2-4.6) vs 2.1 days (1.2-3.8), respectively, P =.73. We confirmed findings with per-protocol analysis, HS and NS groups with 2.0 (1.3-3.3) and 2.0 days (1.2-3.0), respectively, P =.96. Seven-day readmission rate for HS and NS groups were 4.3{\%} and 3.1{\%}, respectively, P =.77. Clinical worsening events were similar between groups (9{\%} vs 8{\%}, P =.97). CONCLUSIONS: Among infants admitted to the hospital with bronchiolitis, treatment with nebulized 3{\%} HS compared with NS had no difference in LOS or 7-day readmission rates.",
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T2 - A randomized controlled trial

AU - Silver, Alyssa H.

AU - Esteban-Cruciani, Nora

AU - Azzarone, Gabriella C.

AU - Douglas, Lindsey C.

AU - Lee, Diana S.

AU - Liewehr, Sheila

AU - Nazif, Joanne M.

AU - Agalliu, Ilir

AU - Villegas, Susan

AU - Rhim, Hai Jung Helen

AU - Rinke, Michael L.

AU - O'Connor, Katherine M.

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