Efficacies of different treatment strategies for infants hospitalized with acute bronchiolitis

Background: Acute bronchiolitis is a common cause of hospitalization during infancy that carries significant morbidity and mortality rates. Purpose: This study compared the efficacy of different treatment modalities for infants with bronchiolitis in terms of hospital stay and clinical severity scores. Methods: The PubMed database was searched for re-levant studies. Eligibility criteria included double-blind randomized controlled trial design, assessment of the effect of treatment on bronchiolitis in infants under 2 years of age, and publication in English from inception through July 31, 2020. The primary efficacy outcome was the length of hospital stay, while the secondary outcome was the clinical severity score. The standardized treatment effect and standard error of the effect size were calculated. Results: We identified 45 randomized controlled trials of 24 pairwise comparisons. These 45 trials included 5,061 participants and investigated 13 types of interventions (12 active, 1 placebo). Inhalation therapy with epinephrine (standard mean difference [SMD],-0.41; 95% confidence interval [CI],-0.8 to-0.03) and hypertonic saline (SMD,-0.29; 95% CI,-0.55 to-0.03) reduced the length of hospital stay compared with normal saline. Hypertonic saline was the most effective at improving the clinical severity score (SMD,-0.52; 95% CI,-0.95 to-0.10). Conclusion: Inhalation therapy with epinephrine and hypertonic saline reduced the length of hospital stay and the clinical severity of bronchiolitis among infants under 2 years of age.