Nebulized Hypertonic Saline for Bronchiolitis
Condition: Bronchiolitis
MeSH terms: Bronchiolitis
Study type: Observational

Summary: 
      In randomized controlled trials, the use of nebulized hypertonic saline in acute
      bronchiolitis has been reported to improve respiratory distress scores, to reduce length of
      hospital stay and to show a trend towards lower hospitalization rates.

      The investigators aim to verify by an observational study if the rate of hospital admission
      and the length of hospital stay of infants presenting to the emergency department (ED) with
      bronchiolitis decreases after the inclusion of 5.85% nebulized hypertonic saline in the
      treatment strategy of the ED and hospitalization wards.

      The investigators will assess the evolution of hospital admission rates and the length of
      hospital stay in two hospitals that use 5.85% nebulized hypertonic saline for the treatment
      of bronchiolitis and in two hospital that do not use these nebulizations. If nebulized
      hypertonic saline is effective in this setting, then the hospitalization rates and length of
      stay should be lower during the year of hypertonic saline use compared to two previous years
      when this therapy was not used. These parameters would not be modified in centers that do not
      use hypertonic saline.
    

Detailed description: 
      This is a before-after observational study designed to compare the results in terms of
      hospitalization rate and length of hospital stay between a period when nebulized hypertonic
      saline was included in the treatment of bronchiolitis in infants versus the two previous
      years when this therapy was not used in two hospitals. There will not be any randomization.

      Physicians have been instructed on the use of hypertonic saline for moderate and severe
      bronchiolitis in infants but its totally up to them whether to use this nebulization for each
      particular patient. Two other hospital where nebulized hypertonic saline has never been used
      and will not be used during the next bronchiolitis epidemics will be the control centers.

      The study comprises two periods, one prospective starting on November 2011 and ending in
      March 2012 and one retrospective including the two previous bronchiolitis epidemics, November
      2009-March 2012 and November 2010-March 2011.

      During the prospective period a standardized assessment of the respiratory status of each
      infant will be carried out before and after each hypertonic saline nebulization.
    

Observational model: Cohort
Time perspective: Prospective
Sampling method: Non-Probability Sample
Study population: 
        For the prospective part of the study, all infants up to 1 year of age presenting to the ED
        for bronchiolitis from November 1st, 2011 to March 30th, 2012 will be included in this
        observational study. For the retrospective part of the study, data of all infants up to 1
        year of age who were seen in the ED for bronchiolitis from November 1st, 2009 and March
        30th, 2010 and from November 1st, 2010 and March 30th, 2011 will be analyzed.
      
Keywords: bronchiolitis; saline; nebulization; hypertonic