title: Nebulised hypertonic saline (3%) among children with mild to moderately severe bronchiolitis--a double blind randomized controlled trial.
abstract: BACKGROUND
  To Assess the efficacy of nebulised hypertonic saline (HS) (3%) among children with mild to moderately severe bronchiolitis.
  
  
  METHODS
  Infants aged 6 weeks to 24 months, with a first episode of wheezing and Clinical Severity scores (Arch Dis Child 67:289-93, 1992) between 1 and 8, were enrolled over 4 months duration. Those with severe disease, co-morbidities, prior wheezing, recent bronchodilator and steroid use were excluded. Patients were randomized in a double-blind fashion, to receive two doses of nebulized 3% HS (Group 1) or 0.9% normal saline (Group 2) with 1.5 mg of L-Epineprine, delivered 30 min apart. Parents were contacted at 24 h and 7 days. The principal outcome measure was the mean change in clinical severity score at the end of 2 h of observation.
  
  
  RESULTS
  A total of 100 infants (mean age 9.6 months, range 2-23 months; 61 % males) were enrolled. Patients in both groups had mild to moderately severe disease at presentation. On an intention-to-treat basis, the infants in the HS group had a significant reduction (3.57 ± 1.41) in the mean clinical severity score compared to those in the NS group (2.26 ± 1.15); [p < 0.001; CI: 0.78-1.82]. More children in the HS group (n = 35/50; 70.0%) were eligible for ER/OPD discharge at the end of 2 h than those in the NS group (n = 15/50; 30%; p < 0.001), and less likely to need a hospital re-visit (n = 5/50; 10.0%) in the next 24 h as compared to the NS group (n = 15/50, 30.0%; p < 0.001). The treatment was well tolerated, with no adverse effects.
  
  
  CONCLUSIONS
  Nebulized 3% HS is effective, safe and superior to normal saline for outpatient management of infants with mild to moderately severe viral bronchiolitis in improving Clinical Severity Scores, facilitating early Out-Patient Department discharge and preventing hospital re-visits and admissions in the 24 h of presentation.
  
  
  BACKGROUND
  Clinicaltrials.gov NCTID012766821. Registered on January 12, 2011.
authors.affiliation: Department of Pediatrics, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj-44600, P.O. Box 1524, Kathmandu, Nepal. aayush_khanal@iom.edu.np.
authors.forename: Aayush
authors.initials: A
authors.lastname: Khanal
authors.affiliation: Department of Pediatrics, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj-44600, P.O. Box 1524, Kathmandu, Nepal. docarunsharma@hotmail.com.
authors.forename: Arun
authors.initials: A
authors.lastname: Sharma
authors.affiliation: Department of Pediatrics, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj-44600, P.O. Box 1524, Kathmandu, Nepal. drsrijanabasnet@yahoo.com.
authors.forename: Srijana
authors.initials: S
authors.lastname: Basnet
authors.affiliation: Department of Pediatrics, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj-44600, P.O. Box 1524, Kathmandu, Nepal. pushparaj.sharma@gmail.com.|Kathmandu Medical College Teaching Hospital, Sinamangal, Kathmandu, Nepal. pushparaj.sharma@gmail.com.
authors.forename: Pushpa Raj
authors.initials: PR
authors.lastname: Sharma
authors.affiliation: Department of Pediatrics, Tribhuvan University Teaching Hospital, Institute of Medicine, Maharajgunj-44600, P.O. Box 1524, Kathmandu, Nepal. fakirgami@hotmail.com.
authors.forename: Fakir Chandra
authors.initials: FC
authors.lastname: Gami
mesh_terms: D000280:Administration, Inhalation; D001990:Bronchiolitis, Viral / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000008:administration & dosage*; D004311:Double-Blind Method; D004359:Drug Therapy, Combination; D004636:Emergency Service, Hospital; D004837:Epinephrine / Q000008:administration & dosage*; D005260:Female; D006801:Humans; D007223:Infant; D008297:Male; D009330:Nebulizers and Vaporizers; D012462:Saline Solution, Hypertonic / Q000008:administration & dosage*; D012720:Severity of Illness Index; D016896:Treatment Outcome
chemical_list: D001993:Bronchodilator Agents; D012462:Saline Solution, Hypertonic; D004837:Epinephrine