Efficacy of 3% Hypertonic Saline Nebulisation in Children Hospitalized with Moderate Bronchiolitis

INTRODUCTION: Bronchiolitis is one of the common causes of lower respiratory tract infections in infants and young children.Bronchiolitis is a predominantly viral disease .The virus which is implicated for more than 50% of cases is the respiratory syncytial virus.Other etiological agents which are implicated in bronchiolitis include parainfluenza, adenovirus and mycoplasma.Other new pathogens which are implicated include human boca virus, and the human metapneumovirus. The human Bocavirus can occur as a coinfection with respiratory syncytial virus. Bronchiolitis mainly occurs during august through november which coincides with respiratory syncytial virus season.The period of infectivity in cases of respiratory syncytial virus is 3 days before to 21 days after onset of symptoms. There are host factors too which have to be considered in case of bronchiolitis.For example bronchiolitis is more commoner in boys than girls.It is more in infants who are deprived of breast milk.It is also more common in overcrowded conditions.The prevalence of bronchiolitis is more in cases of mothers who smoke during pregnancy.Younger mothers too have a higher risk of having a child with bronchiolitis. The clinical manifestation of bronchiolitis is more severe in young infants as they poorly tolerate bronchiolar edema compared to adults.The immunity of the host too plays a significant role in deciding the severity of clinical manifestations.The nature of the virus too plays a role. OBJECTIVES: To establish the efficacy of nebulized hypertonic saline without Bronchodilators in reducing respiratory distress, thereby, clinical severity in cases of moderate bronchiolitis. DISCUSSION: Bronchiolitis is a common cause of lower respiratory infection in the age group less than two years of age. Mostly it is due to a viral etiology. Usually it gets resolved spontaneously and respiratory syncytial virus is the commonest agent contributing to almost 50 % of the disease A study was done in India48 regarding the incidence and the pattern of infection and it was found to be the same as in any other part of the world. The disease has a peak incidence mainly during the months of september through january, but it can occur at any time of the year. In the study done in our hospital the incidence was maximum during the winter months but sporadic cases did occur through out the year. This fact is supported by the study done by John tj et al48 and yeleokar et al49 who studied the seasonal pattern of the disease caused by respiratory syncytial virus. Bronchiolitis usually affects young children and the disease is more severe when it occurs in infants less than six months of age. In our study all chidren less than two years were admitted range 0-24 months). Children in the 6-12 months category constituted the majority in our study. They accounted for 53 % of the cases.This was in contrast to a cohort study done by Fjaerli et al regarding the incidence and risk factors in respiratory syncytial virus disease. Bronchiolitis is more common in males compared to females. In or study too a male predominance was observed accounting for 59 % of all admissions. The male: female ratio in our study was found to be 1.43:1. This observation is consistent with the work done by John tj et al in south india. They studied the etiological factors, incidence , risk factor and clinical presentation of respiratory tract infection in children and came to the conclusion that males were more commonly affected than females. In their study the male is to female ratio was found to be 1.6:1. CONCLUSIONS: In conclusion our study suggests that 3 % hypertonic saline helps to reduce the cough resolution and wheeze resolution time thereby decreasing the clinical severity in hospitalized patients admitted with a diagnosis of moderately severe bronchiolitis. Further studies are required to see if 3 % hypertonic saline has an effect on the length of stay. 3 % hypertonic saline was found to be safe in treating bronchiolitis in children