Comparative Clinical Profile and Early Response to Nebulized 3% Hypertonic Saline versus Adrenaline in Infants with Acute Bronchiolitis

Open Access

Abstract

Background: Acute bronchiolitis is a common viral lower respiratory tract infection and a major cause of hospitalization in infants, most commonly caused by respiratory syncytial virus. Nebulized 3% hypertonic saline (HS) and adrenaline may improve clinical symptoms, but their comparative effectiveness remains uncertain. Evidence from Bangladesh is limited. Therefore, this study aimed to compare the clinical profile and early response to nebulized 3% HS versus adrenaline in infants with acute bronchiolitis, focusing on respiratory distress, oxygen requirement, and hospital stay. Methods & Materials: A prospective randomized study included 120 infants with acute bronchiolitis at Ashiyan Medical College Hospital, Dhaka, from July 2024 to December 2025. Infants were equally randomized to nebulized 3% hypertonic saline or adrenaline. Respiratory parameters were assessed at baseline, 30, 60, and 120 minutes. Early clinical response, oxygen requirement, hospital stay, respiratory support, and adverse events were compared using SPSS, with p<0.05 considered significant. Results: Among 120 infants, baseline demographic and clinical characteristics were comparable between groups. Adrenaline produced significantly greater early improvement in respiratory distress, respiratory rate, and SpO₂, with clinical response at 60 minutes in 71.7% vs. 56.7% (p=0.041). However, these differences diminished by 120 minutes, while hospital stay, oxygen requirement, respiratory support, and adverse events remained comparable. Both treatments were generally safe and well tolerated. Conclusion: Nebulized adrenaline provided greater early clinical improvement than 3% hypertonic saline, particularly within the first hour of treatment. However, both therapies demonstrated comparable short-term hospital outcomes, minimal adverse events, and favorable safety profiles in infants with acute bronchiolitis.