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WHAT’S KNOWN ON THIS SUBJECT: Bronchiolitis, Division of Pediatric Hospital Medicine, Department of Pediatrics, eDepartment of Pharmacy, The Children’s
Hospital at Montefiore, and cDepartment of Epidemiology and Population Health, Albert Einstein College of
the most frequent reason for hospitalization for Medicine, Bronx, New York; bDepartment of Pediatrics, Steven and Alexandra Cohen Children’s Medical Center at
infants younger than 1 year of age, has no North Shore-LIJ Health System, New Hyde Park, New York; and dDepartment of Pharmacy, Arnold and Marie
Schwartz College of Pharmacy, Long Island University, Brooklyn, New York
proven treatments beyond supportive care.
Although early studies suggested a potential Dr Silver conceptualized and designed the study, coordinated and supervised data collection, participated
benefit from 3% hypertonic saline, more recent in acquisition, analysis, and interpretation of the data, and drafted the initial manuscript; Drs Esteban-
Cruciani, Azzarone, Douglas, Lee, Liewehr, Nazif, and Rhim helped with design of the study and acquisition
studies have conflicting results. of data, and reviewed the manuscript critically; Dr Agalliu contributed to study design, analysis and
interpretation of data, and critically reviewed the manuscript; Dr Villegas contributed to study
WHAT THIS STUDY ADDS: This prospective,
conceptualization and design, and critically reviewed the manuscript; Dr Rinke was involved in the analysis
randomized, double-blind, controlled trial in and interpretation of the data, and drafting and revising the manuscript; Dr O’Connor conceptualized and
infants admitted with bronchiolitis (including designed the study, coordinated and supervised data collection, participated in acquisition, analysis,
and interpretation of the data, and reviewed and revised the manuscript; and all authors approved the
patients with a history of previous wheeze)
final manuscript as submitted and agree to be accountable for all aspects of the work.
demonstrated no difference in length of stay
This trial has been registered at www.clinicaltrials.gov (identifier: NCT01488448).
between those who received hypertonic saline or
normal saline without bronchodilators. www.pediatrics.org/cgi/doi/10.1542/peds.2015-1037
DOI: 10.1542/peds.2015-1037
Accepted for publication Sep 17, 2015
RESULTS
We assessed 765 patients for
eligibility and enrolled 227 subjects
(Fig 1). Analyses were all by original FIGURE 1
assigned groups. There were no Patient enrollment flow diagram.
statistical differences between
intervention and control groups for
demographics and patient interim futility analysis indicated that analyses by RSV infection, history of
characteristics (Table 1). Of subjects neither arm could achieve superiority previous wheeze, history of
with a race “Other,” most parents/ with further enrollment. prematurity, and those with study
guardians identified the patient as There was no difference in LOS entry RDAI $4 or hypoxia, although
Hispanic. Eighty of 190 patients who between HS intervention and NS underpowered, also found no
completed the study qualified as control groups by intention-to-treat differences in LOS between study
moderately ill based solely on RDAI analysis. The median LOS was groups (Table 4).
score $4 on study entry. Additionally, 2.1 days in the HS group and 2.1 days There was no difference when
of those with RDAI score ,4, nearly in the NS group, P = .73 (Table 3). comparing mean change in RDAI
half (49/110) were hypoxic, an These findings were confirmed with a before and after initial study
element of clinical severity not per-protocol analysis, demonstrating treatment between study groups;
evaluated in the RDAI score. A total of a median LOS of 2.0 days mean change in score for HS was 0.21
37 patients withdrew from the study (interquartile range [IQR] 1.3–3.3) for and in NS was 0.18 (P = .81).
in the final per-protocol analysis HS and 2.0 days (IQR 1.2–3.0) for NS, Additionally, there was no difference
(Fig 1); the proportion withdrawn
P = .96. For further verification, we in the proportion of patients who
was similar between intervention and
compared LOS calculated as time received PRN study treatments
control groups (17.6% vs 14.9%,
from admission order to discharge between HS and NS groups (8.6% vs
respectively, P = .59) (Supplemental
Table 5). Patient characteristics were
order. In this analysis, median LOS 3.1%, P = .13).
was 2.6 days (IQR 1.6–4.7) in the HS
similar between included and No primary outcome (LOS) data were
group and 2.5 days (IQR 1.6–3.9) in
withdrawn patients, except for a higher missing. Readmission rate had 10
proportion of patients with previous the NS group, P = .76. missing data points (4 HS, 6 NS;
wheeze and prematurity in the There were no differences in Fisher’s exact P = .75), due to inability
withdrawn group (Table 2). We closed readmission rates or adverse events to reach parents/guardians in follow-
enrollment in the study after achieving between intervention and control up phone call. There were no
a sample size of 227 patients because groups (Table 3). Post hoc subgroup significant differences among those
Address correspondence to Alyssa H. Silver, MD, Children’s Hospital at Montefiore, Department of Pediatrics, 3415 Bainbridge Ave, Bronx, NY 10467. E-mail: alysilve@
montefiore.org
PEDIATRICS (ISSN Numbers: Print, 0031-4005; Online, 1098-4275).
Copyright © 2015 by the American Academy of Pediatrics
FINANCIAL DISCLOSURE: The authors have indicated they have no financial relationships relevant to this article to disclose.
FUNDING: No external or governmental support was provided for this study. Montefiore Medical Center internally supported the pharmacy cost of the study
medication in this investigator-initiated study.
POTENTIAL CONFLICT OF INTEREST: The authors have indicated they have no potential conflicts of interest to disclose.
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