Multiple Factors Analysis For Efficacy Of Nebulized3%Hypertonic Saline In Inpatient Children With Bronchiolitis: A Retrospective Study

OBJECTIVE Bronchiolitis is the most common lower respiratorytract infection causing by viruses among children under2years-old.Respiratory syncytial virus (RSV) is the major pathogen. Because there areno curative medicines for viruses and the application of corticosteroid,bronchodilator and antiviral pharmaceuticals remain controversial, themainstay of treatment remains supportive care. Recently, nebulized3%hypertonic saline solution was broadly used in bronchiolitis because of itsability of absorbing water from the submucosa, thereby decreasing edemaand improving mucociliary function. Furthermore, several studies reportedthat infants with bronchiolitis benefitted from the therapy of nebulized3%saline solution. However, we found the efficacy of nebulized3%hypertonicsaline for bronchiolitis varied with individual differences in clinic. So weconducted a retrospective research to explore factors associated withefficacy of nebulized3%hypertonic saline for infants with bronchiolitis.METHODS We conducted a retrospective research during June2009 to December2012in Children’s Hospital of Chongqing Medical University.Hospitalized infants aged<2years with bronchiolitis (defined as the firstepisode of wheezing with manifestations of a viral respiratory infection)were recruited by systematic sampling from different months to detect16kinds of respiratory tract virus. Data collections included patients’demographic, clinical characteristics, investigations and pathogens.Several researches had proven that most effect of nebulized3%HS occurredon the first2days of treatment. According to this condition, we judged theefficacy by whether in the need of adding or switching to alternativemedications (bronchodilators or corticosteroids)within first2days’treatment of nebulized3%HS. And the percentage fall of clinic severityscore after2days’treatment was calculated to assess magnitude of remissionin effective group.RESULTS2125specimens were chosen by systematic sampling fromdifferent months to detect16kinds of respiratory tract virus during June2009to December2012, of which441patients were first diagnosed asbronchiolitis. Among them,387patients were treated without nebulized3%hypertonic saline solution, and30patients’ were excluded forincompleted information. Finally, the retrospective study enrolled357infants,266(74.51%) of which were effective. In the multivariable logisticregression model predicting efficacy of nebulized3%hypertonic saline, thesignificant associated factors were: exclusively breastfeeding (odds ratio [OR]1.78；95%confidence interval [CI]1.09–2.91),began receivingnebulized3%hypertonic saline therapy within10day after onset (OR2.24；95%CI1.26–4.00),diffused wheezing on auscultation (OR2.63；95%CI1.18–5.84). Furthermore, the multiple linear regression model predictedthat children remit highly were worse cases and had normal level ofC-reactive protein.CONCLUSIONS1. Nebulized3%hypertonic saline solution was74.5%effective inbronchiolitis and the efficacy had nothing to do with pathogens. Nebulized3%hypertonic saline solution therapy could be chosen for infants withbronchiolitis ignoring what kind of virus was detected.2. Nebulized3%hypertonic saline therapy should be more suitable forchildren who were exclusively breastfed, were admitted within10days afteronset, could be heard diffused wheezing on auscultation.3. Children most likely to remit highly were worse cases and hadnormal level of C-reactive protein.