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Inhaled adrenaline no better than inhaled saline for babies with bronchiolitis

BMJ 2013; 346 doi: http://dx.doi.org/10.1136/bmj.f3848 (Published 18 June 2013) Cite this as: BMJ 2013;346:f3848

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A new trial challenges a widespread treatment for infants with bronchiolitis. Inhalations of racemic adrenaline worked no better than inhalations of saline in infants admitted to Norwegian hospitals. Infants given adrenaline were discharged no faster (63.6 v 68.1 h; difference 4.5, 95% CI −6.5 to 15.5) and were no less likely to need supplementary oxygen, nasogastric feeding, or ventilator support than controls. Both groups had comparable improvements in clinical scores after their first inhalation. Subgroup analyses hinted at longer admissions for babies under 8 weeks old given racemic adrenaline.

The trial had a factorial design and infants had their inhalations on demand or according to a fixed schedule. Those treated on demand had fewer inhalations overall and went home nearly 14 hours earlier than those treated to a fixed schedule (13.7 h, 95% CI 2.9 to 24.4). They were significantly less likely to need supplementary oxygen or ventilatory support (4% (8/200) v 10.8% (22/204); rate ratio 0.37, 0.17 to 0.81).

The trial was smaller than planned, but the authors are confident that they had enough power to rule out a clinically meaningful difference between inhaled adrenaline and saline, except possibly in the youngest babies. Treatment on demand looked superior to fixed schedules in this first head to head comparison. Respiratory syncytial virus was the most common cause of bronchiolitis in the 123 children who were tested (80.5%, 99/123).

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Cite this as: BMJ 2013;346:f3848