Please select the eligibility criteria that correspond to the clinical trial below.
Title: Inhaled Hypertonic Saline to Reduce Hospital Admissions in Infants With Viral Bronchiolitis (HS in ER Study)
Brief Summary: Inhaled 3% hypertonic saline (HS) administered every 2-8 hours to infants admitted to hospital with viral bronchiolitis has been shown to improve airway clearance and reduces length of stay.

Hypothesis: When infants first present to the ER, frequent administration of HS over a brief time period will provide significant symptom improvement such that the need for hospital admission will be reduced.

Objective: To determine in a randomized, controlled and double-blind fashion if the short term intensive use of inhaled 3% hypertonic saline (HS) in the Emergency Room (ER) can reduce the rate of hospital admission for infants presenting with moderately severe viral bronchiolitis.


Options:
A: Inclusion Criteria:

* Infants aged ≤ 18 months presenting to the unit for the treatment of moderate-severe viral bronchiolitis were eligible for the study.
* Moderate-severe bronchiolitis required having a prodromal history consistent with viral upper respiratory tract infection followed by wheezing and/or crackles on auscultation and a Wang bronchiolitis severity score of ≥ 4 on presentation.

Exclusion Criteria:

Patients were excluded from the study if they had one or more of the following characteristics:

* Born preterm ≤ 34 weeks gestation,
* Previous history of wheezing,
* Steroid use within 48 hours of presentation,
* Obtundation and progressive respiratory failure requiring ICU admission,
* History of apnea with in 24 hours before presentation,
* Oxygen saturation ≤ 85% on room air at the time of recruitment,
* History of a diagnosis of chronic lung disease,
* Congenital heart disease, or
* Immunodeficiency.
B: Inclusion Criteria:

* clinical diagnosis of viral bronchiolitis
* between November and April

Exclusion Criteria:

* prematurity \< 34 weeks
* chronic lung disease
* congenital heart disease
* history of wheezing, asthma or albuterol use
* tracheostomy status
* need for intensive care of assisted ventilation
C: Inclusion Criteria:

* Patients age 6 weeks to ≤ 18 months
* Diagnosed with bronchiolitis (defined as viral respiratory illness and first episode of wheeze)
* BSS score of ≥ 4

Exclusion Criteria:

* A previous history of wheezing;
* diagnosis of asthma;
* any use of bronchodilators within 2 h of presentation
* gestational age ≤ 34 weeks
* history of congenital heart disease
* chronic pulmonary or chronic renal disease
* oxygen saturation of ≤ 85% at the time of recruitment
* severe disease requiring intensive care unit admission
* inability to obtain informed consent
D: Inclusion Criteria:

1. \< 24 months.
2. presenting to ER or outpatient department with moderately severe viral bronchiolitis defined as:

   1. history of viral upper respiratory tract infection within previous 7 days, plus
   2. presence of wheezing and/or crackles on chest auscultation, plus
   3. Respiratory Distress Assessment Instrument (RDAI, appendix B) score \> 4 (of 17) or transcutaneous oxygen saturation (SaO2) \< 94% in room air.

Patient exclusion criteria:

1. history of immunodeficiency or chronic cardiopulmonary disease (other than past history of wheezing).
2. critical illness at presentation.
3. use of nebulized HS within previous 12 hr.
4. prematurity (gestational age \< 34 weeks).

Answer: D