A Randomized Control Comparative Trial of Nebulized Magnesium Sulfate and Hypertonic Saline In Acute Bronchiolitis
Comparative Trial of Nebulized Magnesium Sulfate and Hypertonic Saline
Introduction: Acute bronchiolitis is the common lower respiratory tract illness requiring hospitalization in children < 2years. Vaious treatment modalities proposed to manage the acute bronchiolitis. But no study has been recommended for the treatment other than supportive management. Hence this study aims to study the efficacy of nebulized magnesium sulfate in acute bronchiolitis. Subjects and Methods: A hospital-based randomized prospective comparative clinical observational study conducted in 110 children with mild to moderate bronchiolitis, randomly divided into two groups; Group 1 received 4 ml of hypertonic saline nebulization with 100% oxygen at an interval of 20mins for the first three doses and then 4thhourly. Group 2, received 0.1-0.2 ml/kg/dose of 25% magnesium sulfate made to 4ml with 0.9% normal saline. Heart rate, oxygen saturation, respiratory rate, and Respiratory Distress Assessment Instrument (RDAI) scores were monitored throughout the study. Results: The mean age was 7.5 + 3.2 months, 6.5 + 3 months in group 1, and group 2 without significant difference(p=0.6). 30(54.54%) cases, and 25(45.45) cases belongs to mild and moderate category of bronchiolitis in group1, and 28(52.7%) cases and 27 (47.27%) cases belongs to the mild and moderate category of bronchiolitis in group 2 (p>0.05). 8(14.54%) cases had leukocytosis and 2 (3.63%) cases had leucopenia in group 1, whereas, Leukocytosis and leucopenia were present in 12(21.81%) and 2(3.63%) cases respectively in group 2. The most common chest X-ray findings in acute bronchiolitis were hyperinflation followed by segmental atelectasis. The mean hospital stay in nebulized with hypertonic saline and magnesium sulfate was 3.5 + 1.0 days and 3.0 + 1.1 days, respectively. The length of hospital stay between hypertonic saline and magnesium sulfate group was slightly longer in moderate bronchiolitis. Conclusion: The mean hospital stay in nebulized with hypertonic saline is higher than and magnesium sulfate. RDAI score does not vary significantly between two groups after nebulization. Further trials with large sample size, the inclusion of children with severe bronchiolitis, and assessment of long-term outcomes are recommended.
Lieberthal AS, Bauchner H, Hall C, American Academy of Pediatrics Subcommittee on Diagnosis and Management of Bronchiolitis. Diagnosis and management of bronchiolitis. Pediatrics. 2006;118(4):1774–1793. Available from: https://doi.org/10.1542/peds.2006-2223.
Ravaglia C, Venerinopoletti. Recent advances in the manage- ment of acute bronchiolitis. F1000Prime Rep. 2014;6:103–104. Available from: https://doi.org/10.12703/p6-103.
Shi T, David A, Mcallister K, Brien LO. Global, regional, and national disease burden estimates of acute lower respiratory infections due to respiratory syncytial virus in young children in 2015: a systematic review and modelling study. Lancet. 2017;390:946–58. Available from: https://doi.org/10.1016/s0140-6736(17)30938-8.
Boncristiani HF, Criado MF, Arruda E. Respiratory Viruses. Encyclopedia of Microbiology. 2009;500-518. 2013;Available from: https://dx.doi.org/10.1016/B978-012373944-5.00314-X.
Ali S, Plint AC, Klassen TP. Bronchiolitis. Kendig & Chernick’s Disorders of the Respiratory Tract in Children. 2012;443-452. ;Available from: https://dx.doi.org/10.1016/B978-1-4377-1984-0.00027-9.
AAP Releases Practice Guideline on Diagnosis, Management, and Prevention of Bronchiolitis. Am Fam Physician. 2015;91(8):578–580.
Unger S, Halliday C, Cunningham S. G489Blood gas analysis in acute bronchiolitis – who and when? BMJ. 2016;101(1):290. Available from: https://www.researchgate.net/deref/http%3A//dx.doi.org/10.1136/archdischild-2016-310863.476.
Dominguez LJ, Barbagallo M, Lorenzo GD, Drago A, Scola S, Morici G, et al. Bronchial reactivity and intracellular magnesium: a possible mechanism for the bronchodilating effects of magnesium in asthma. Clin Sci. 1998;95:137–142.
Rowe BH, Jr CAC. The role of magnesium sulfate in the acute and chronic management of asthma. Curr Opin Pulm Med. 2008;14(1):70–76. Available from: https://doi.org/10.1097/mcp.0b013e3282f19867.
Song WJ, Chang YS. Magnesium sulfate for acute asthma in adults: a systematic literature review. Asia Pac Allergy. 2012;2(1):76-85. ;Available from: https://dx.doi.org/10.5415/apallergy.2012.2.1.76.
Anderson C, Hillman NH. Bronchopulmonary Dysplasia: When the Very Preterm Baby Comes Home. Mo Med. 2019;116(2):117-122.;.
Parrott RH, Kim HW, Arrobio JO, Hodes DS, Murphy BR, Brandt CD, et al. Epidemiology of respiratory syncytial virus infection in Washington, D.C. II. Infection and disease with respect to age, immunologic status, race and sex. Am J Epidemiol. 1973;98(4):289–300. Available from: https://doi.org/10.1093/oxfordjournals.aje.a121558.
Nagayama Y, Tsubaki T, Nakayama S, Sawada K, Taguchi K, Tateno N, et al. Gender analysis in acute bronchiolitis due to respiratory syncytial virus. Pediatr Allergy Immunol. 2006;17:29–36. Available from: https://dx.doi.org/10.1111/j.1399-3038.2005.00339.x.
Boezen HM, Jansen DF, Postma DS. Sex and gender differences in lung development and their clinical significance. Clin Chest Med . 2004;25(2):237–245. Available from: https://dx.doi.org/10.1016/j.ccm.2004.01.012.
El-Radhi AS, Barry W, Patel S. Association of fever and severe clinical course in bronchiolitis. Arch Dis Child.1999;81(3):231–234. Available from: https://dx.doi.org/10.1136/adc.81.3.231.
Robert. Should Infants with Bronchiolitis Have Chest X-Rays? J Pediatr. 2007;150:429–462.
Akhter J, Johani SA;.
Kaur. Role of CRP in Lower Respiratory Tract Infections. J Nepal Paediatr Soc. 2013;33(2):117–120. Available from: https://doi.org/10.3126/jnps.v33i2.8106.
Costa S, Rocha R, Tavares M, Bonito-Vítor A. C Reactive protein and disease severity in bronchiolitis. Rev Port Pneumol. 2009;15(1):55–65.
Fares M, Mourad S, Rajab M, Rifai N. The use of C-reactive protein in predicting bacterial co-Infection in children with bronchiolitis. N Am J Med Sci. 2011;3(3):152–156. Available from: https://dx.doi.org/10.4297/najms.2011.3152.
Saijo M, Ishii T, Kokubo M, Murono K, Takimoto M, Fujita K. White blood cell count, C-reactive protein and erythrocyte sedimentation rate in respiratory syncytial virus infection of the lower respiratory tract. Acta Paediatr Jpn. 1996;38(6):596– 600. Available from: https://dx.doi.org/10.1111/j.1442-200x.1996.tb03714.x.
Asaad A Atiya. Hypertonic 3% Saline in Comparison with 0.9% (Normal) Saline in Treatment of Acute Bronchiolitis. Int J Pediatr. 2017;5(37):4209–4225.
Modaresi MR, Faghihinia J, Kelishadi R, Reisi M, Mirlohi S, Pajhang F, et al. Nebulized Magnesium Sulfate in Acute Bronchiolitis: A Randomized Controlled Trial. Indian J Pediat. 2015;82(9):794–798. Available from: https://dx.doi.org/10.1007/s12098-015-1729-z.
Kose M, Ozturk MA, Poyrazoğlu H, Elmas T, Ekinci D, Tubas F, et al. The efficacy of nebulized salbutamol, magnesium sulfate, and salbutamol/magnesium sulfate combination in moderate bronchiolitis. Eur J Pediat. 2014;173(9):1157–1160. Available from: https://dx.doi.org/10.1007/s00431-014-2309-3.
Copyright (c) 2021 Author
This work is licensed under a Creative Commons Attribution 4.0 International License.