So much for hypertonic saline for bronchiolitis…

I thought I’d blogged on it, but I can’t find the post. Maybe I dreamed it. Anyway, a couple years ago, people were touting hypertonic saline as a potential therapy for kids with bronchiolitis. They had evidence.

Short side note here: Bronchiolitis is a lower airway infection, often caused by RSV, that can be bad for infants and toddlers. We don’t have much we can do for them other than supportive care. The vast majority of kids get better on their own. Some people recommend bronchodilators, but I spent most of my early training and career railing against such people, cause the evidence says they don’t work well, and they have side effects. In fact, I probably had more fights about bronchiolitis in residency than any other topic. Except wedges. And, later, D’Allergy. That’s a topic for another day, though.

In 2016, a re-analysis of 2 meta-analyses threw some cold water on the hopes for hypertonic saline. Researchers argued that outliers and unbalanced treatment groups were responsible for the positive results. And then, this month, JAMA Pediatrics just published a large randomized controlled trial that might help settle the debate.

They randomized 777 healthy infants to get nebulized hypertonic saline (3%) or normal saline (0.9%) in the Emergency department. This was multicenter, multi-season, in France. The outcome of interest was the admission rate to the hospital.

They found that 48% of those getting hypertonic saline were admitted compared to 52% of kids getting normal saline. The differences were not statistically significant. There were also more mild adverse events, like cough, in the hypertonic saline group.

So… no real benefit and some minor harm. The accompanying editorial was entitled, “Could This Be the Last Word on Hypertonic Saline?” Given my previous experience with failed treatments for bronchiolitis, I’d answer, “no”, but maybe we’ve learned since then.


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