Inhaled racemic adrenaline is no more effective than inhaled saline for infants hospitalized with acute bronchiolitis, according to a report published online June 12 in the New England Journal of Medicine.
In a multicenter, double-blind randomized trial involving 404 infants in Norway, hospital length of stay was no shorter for patients who received inhaled adrenaline than for those who received inhaled saline. The need for nasogastric-tube feeding, supplemental oxygen, or ventilatory support also was no different between the two groups, said Dr. Havard Ove Skjerven of Oslo University Hospital and his associates.
Adrenaline inhalation, which reduces mucosal swelling, is used frequently for acute bronchiolitis in the outpatient setting, chiefly because it has been shown to improve symptoms and prevent the need for hospitalization. "Among inpatients, however, adrenaline has not been found to reduce the length of hospital stay," the investigators noted.
They studied the issue in babies aged younger than 1 year (mean age, 4 months) who were admitted to the pediatric departments of eight hospitals during a 1-year period. A total of 102 infants were randomly assigned to receive inhaled adrenaline on demand, 101 to receive inhaled adrenaline on a fixed schedule, 98 to receive saline on demand, and 103 to receive saline on a fixed schedule.
The primary outcome was length of hospital stay. The mean length of stay for the entire study population was 80 hours.
There was no significant difference in length of hospital stay between the infants treated with adrenaline (78.7 hours) and those treated with saline (81.8 hours).
There also were no significant between-group differences in the need for feeding using a nasogastric tube, supplemental oxygen, or ventilatory support. the researchers said (N. Engl. J. Med. 2013 June 12 [doi:10.1056/NEHMoa1301839]).
In addition, the infants were scored on a measure of clinical appearance, which took into account their general condition, skin color, findings on auscultation, respiratory rate, and chest retractions. These scores also did not differ significantly between infants given their first dose of inhaled adrenaline and those given their first dose of inhaled saline.
The two study groups also were similar in the number of children who discontinued the study medication. No serious adverse events were reported.
These findings did not change in a subgroup analysis that categorized the infants by age (younger vs. older than 3 months). They also remained robust regardless of whether the patients had a history of atopic eczema or wheezing, or a family history of atopy.
However, it was notable that among the youngest patients (less than 3 months of age), length of hospital stay was significantly shorter and secondary outcomes were better for those who received either adrenaline or saline inhalation on demand than for those who received either drug on a fixed schedule. Because the on-demand groups received a mean of 5 (30%) fewer inhalations than the fixed-schedule groups, this suggests that "minimal handling" – allowing infants to sleep, with minimal interruptions – is the preferred approach for this age group, Dr. Skjerven and his associates said.
This study was supported by Medicines for Children, a publicly funded group administered by Haukeland University Hospital. Dr. Skjerven reported no relevant financial disclosures; his associates reported ties to numerous industry sources.