Skip to main content
Top
Published in: Indian Journal of Pediatrics 9/2015

01-09-2015 | Original Article

Nebulized Magnesium Sulfate in Acute Bronchiolitis: A Randomized Controlled Trial

Authors: Mohammad Reza Modaresi, Jamal Faghihinia, Roya Kelishadi, Mohsen Reisi, Shahrokh Mirlohi, Farhad Pajhang, Majid Sadeghian

Published in: Indian Journal of Pediatrics | Issue 9/2015

Login to get access

Abstract

Objective

To assess the efficacy of nebulized magnesium sulfate as a bronchodilator in infants hospitalized with acute bronchiolitis.

Methods

This three-center double masked randomized clinical trial comprised 120 children with moderate to severe bronchiolitis. They were randomly assigned into two groups: the first group was treated with nebulized magnesium sulfate (40 mg/kg) and nebulized epinephrine (0.1 ml/kg) and the second group (control) was treated with nebulized epinephrine (0.1 ml/kg). The primary outcome was the length of hospital stay. The use of oxygen, temperature, oxygen saturation (SPO2), pulse rate (PR), respiratory rate (RR) and respiratory distress assessment instrument (RDAI) score were measured in the beginning of the study and during hospitalization.

Results

The mean (SD) age of 120 infants was 5.1(±2.6) mo and 60% were boys. The length of hospital stay was not different between the two groups (P > 0.01). Use of oxygen supplementation, SPO2 and vital signs were similar in the two groups. Improvement in RDAI score was significantly better in infants treated with nebulized magnesium sulfate than in the other group (P 0.01).

Conclusions

Thus, in infants with acute bronchiolitis, the effect of nebulized magnesium sulfate is comparable to nebulized epinephrine. However nebulized magnesium sulfate can improve the clinical score so it may have additive effect to reduce symptoms during hospitalization.
Literature
1.
go back to reference Gupta S, Shamsundar R, Shet A, Chawan R, Srinivasa H. Prevalence of respiratory syncytial virus infection among hospitalized children presenting with acute lower respiratory tract infections. Indian J Pediatr. 2011;78:1495–7.CrossRefPubMed Gupta S, Shamsundar R, Shet A, Chawan R, Srinivasa H. Prevalence of respiratory syncytial virus infection among hospitalized children presenting with acute lower respiratory tract infections. Indian J Pediatr. 2011;78:1495–7.CrossRefPubMed
2.
go back to reference Goodman D. Inflammatory disorder of the small airways, 387 Bronchiolitis. In: Behrman RE, Kliegman RM, Jenson HB, editors. Bronchiolitis: text book of pediatrics. 17th edition. Philadelphia: Saunders; 2004. p. 1415–7. Goodman D. Inflammatory disorder of the small airways, 387 Bronchiolitis. In: Behrman RE, Kliegman RM, Jenson HB, editors. Bronchiolitis: text book of pediatrics. 17th edition. Philadelphia: Saunders; 2004. p. 1415–7.
3.
go back to reference Wright A, Taussig LM, Ray CG, Harrison HR, Holberg CJ. The Tucson children’s respiratory study. II. Lower respiratory tract illness in the first year of life. Am J Epidemiol. 1989;129:1232–46.PubMed Wright A, Taussig LM, Ray CG, Harrison HR, Holberg CJ. The Tucson children’s respiratory study. II. Lower respiratory tract illness in the first year of life. Am J Epidemiol. 1989;129:1232–46.PubMed
4.
go back to reference Shay DK, Holman RC, Newman RD, Liu LL, Stout JW, Anderson LJ. Bronchiolitis-associated hospitalizations among US children, 1980–1996. JAMA. 1999;282:1440–6.CrossRefPubMed Shay DK, Holman RC, Newman RD, Liu LL, Stout JW, Anderson LJ. Bronchiolitis-associated hospitalizations among US children, 1980–1996. JAMA. 1999;282:1440–6.CrossRefPubMed
5.
go back to reference Langley JM, Smith MB, LeBlanc JC, Joudrey H, Ojah CR, Pianosi P. Racemic epinephrine compared to salbutamol in hospitalized young children with bronchiolitis; a randomized controlled clinical trial [ISRCTN46561076]. BMC Pediatr. 2005;5:7.CrossRefPubMedPubMedCentral Langley JM, Smith MB, LeBlanc JC, Joudrey H, Ojah CR, Pianosi P. Racemic epinephrine compared to salbutamol in hospitalized young children with bronchiolitis; a randomized controlled clinical trial [ISRCTN46561076]. BMC Pediatr. 2005;5:7.CrossRefPubMedPubMedCentral
6.
go back to reference Kellner JD, Ohlsson A, Gadomski AM, Wang EE. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev. 2000;2:CD001266.PubMed Kellner JD, Ohlsson A, Gadomski AM, Wang EE. Bronchodilators for bronchiolitis. Cochrane Database Syst Rev. 2000;2:CD001266.PubMed
7.
go back to reference Tudor GJ, Hafner JW. In infants younger than 24 months old and with bronchiolitis, does nebulized epinephrine improve clinical status? Ann Emerg Med. 2013;61:289–90.CrossRefPubMed Tudor GJ, Hafner JW. In infants younger than 24 months old and with bronchiolitis, does nebulized epinephrine improve clinical status? Ann Emerg Med. 2013;61:289–90.CrossRefPubMed
8.
go back to reference Beck R, Elias N, Shoval S, et al. Computerized acoustic assessment of treatment efficacy of nebulized epinephrine and albuterol in RSV bronchiolitis. BMC Pediatr. 2007;7:22.CrossRefPubMedPubMedCentral Beck R, Elias N, Shoval S, et al. Computerized acoustic assessment of treatment efficacy of nebulized epinephrine and albuterol in RSV bronchiolitis. BMC Pediatr. 2007;7:22.CrossRefPubMedPubMedCentral
9.
go back to reference Gourgoulianis KI, Chatziparasidis G, Chatziefthimiou A, Molyvdas PA. Magnesium as a relaxing factor of airway smooth muscles. J Aerosol Med. 2001;14:301–7.CrossRefPubMed Gourgoulianis KI, Chatziparasidis G, Chatziefthimiou A, Molyvdas PA. Magnesium as a relaxing factor of airway smooth muscles. J Aerosol Med. 2001;14:301–7.CrossRefPubMed
10.
go back to reference Scarfone RJ, Loiselle JM, Joffe MD, et al. A randomized trial of magnesium in the emergency department treatment of children with asthma. Ann Emerg Med. 2000;36:572–8.CrossRefPubMed Scarfone RJ, Loiselle JM, Joffe MD, et al. A randomized trial of magnesium in the emergency department treatment of children with asthma. Ann Emerg Med. 2000;36:572–8.CrossRefPubMed
11.
go back to reference Okayama H, Aikawa T, Okayama M, Sasaki H, Mue S, Takishima T. Bronchodilating effect of intravenous magnesium sulfate in bronchial asthma. JAMA. 1987;257:1076–8.CrossRefPubMed Okayama H, Aikawa T, Okayama M, Sasaki H, Mue S, Takishima T. Bronchodilating effect of intravenous magnesium sulfate in bronchial asthma. JAMA. 1987;257:1076–8.CrossRefPubMed
12.
go back to reference Bloch H, Silverman R, Mancherje N, Grant S, Jagminas L, Scharf SM. Intravenous magnesium sulfate as an adjunct in the treatment of acute asthma. Chest. 1995;107:1576–81.CrossRefPubMed Bloch H, Silverman R, Mancherje N, Grant S, Jagminas L, Scharf SM. Intravenous magnesium sulfate as an adjunct in the treatment of acute asthma. Chest. 1995;107:1576–81.CrossRefPubMed
13.
go back to reference Ciarallo L, Sauer AH, Shannon MW. Intravenous magnesium therapy for moderate to severe pediatric asthma: results of a randomized, placebo-controlled trial. J Pediatr. 1996;129:809–14.CrossRefPubMed Ciarallo L, Sauer AH, Shannon MW. Intravenous magnesium therapy for moderate to severe pediatric asthma: results of a randomized, placebo-controlled trial. J Pediatr. 1996;129:809–14.CrossRefPubMed
14.
go back to reference Sarrell EM, Tal G, Witzling M, et al. Nebulized 3% hypertonic saline solution treatment in ambulatory children with viral bronchiolitis decreases symptoms. Chest. 2002;122:2015–20.CrossRefPubMed Sarrell EM, Tal G, Witzling M, et al. Nebulized 3% hypertonic saline solution treatment in ambulatory children with viral bronchiolitis decreases symptoms. Chest. 2002;122:2015–20.CrossRefPubMed
15.
go back to reference Ralston S, Hartenberger C, Anaya T, Qualls C, Kelly HW. Randomized, placebo-controlled trial of albuterol and epinephrine at equipotent beta-2 agonist doses in acute bronchiolitis. Pediatr Pulmonol. 2005;40:292–9.CrossRefPubMed Ralston S, Hartenberger C, Anaya T, Qualls C, Kelly HW. Randomized, placebo-controlled trial of albuterol and epinephrine at equipotent beta-2 agonist doses in acute bronchiolitis. Pediatr Pulmonol. 2005;40:292–9.CrossRefPubMed
16.
go back to reference Levin DL, Garg A, Hall LJ, Slogic S, Jarvis JD, Leiter JC. A prospective randomized controlled blinded study of three bronchodilators in infants with respiratory syncytial virus bronchiolitis on mechanical ventilation. Pediatr Crit Care Med. 2008;9:598–604.CrossRefPubMed Levin DL, Garg A, Hall LJ, Slogic S, Jarvis JD, Leiter JC. A prospective randomized controlled blinded study of three bronchodilators in infants with respiratory syncytial virus bronchiolitis on mechanical ventilation. Pediatr Crit Care Med. 2008;9:598–604.CrossRefPubMed
17.
go back to reference Livni G, Rachmel A, Marom D, Yaari A, Tirosh N, Ashkenazi S. A randomized, double-blind study examining the comparative efficacies and safety of inhaled epinephrine and nasal decongestant in hospitalized infants with acute bronchiolitis. Pediatr Infect Dis J. 2010;29:71–3.CrossRefPubMed Livni G, Rachmel A, Marom D, Yaari A, Tirosh N, Ashkenazi S. A randomized, double-blind study examining the comparative efficacies and safety of inhaled epinephrine and nasal decongestant in hospitalized infants with acute bronchiolitis. Pediatr Infect Dis J. 2010;29:71–3.CrossRefPubMed
18.
go back to reference Anil AB, Anil M, Saglam AB, Cetin N, Bal A, Aksu N. High volume normal saline alone is as effective as nebulized salbutamol-normal saline, epinephrine-normal saline, and 3% saline in mild bronchiolitis. Pediatr Pulmonol. 2010;45:41–7.CrossRefPubMed Anil AB, Anil M, Saglam AB, Cetin N, Bal A, Aksu N. High volume normal saline alone is as effective as nebulized salbutamol-normal saline, epinephrine-normal saline, and 3% saline in mild bronchiolitis. Pediatr Pulmonol. 2010;45:41–7.CrossRefPubMed
19.
go back to reference Hartling L, Bialy LM, Vandermeer B, et al. Epinephrine for bronchiolitis. Cochrane Database Syst Rev. 2011;6:CD003123.PubMed Hartling L, Bialy LM, Vandermeer B, et al. Epinephrine for bronchiolitis. Cochrane Database Syst Rev. 2011;6:CD003123.PubMed
Metadata
Title
Nebulized Magnesium Sulfate in Acute Bronchiolitis: A Randomized Controlled Trial
Authors
Mohammad Reza Modaresi
Jamal Faghihinia
Roya Kelishadi
Mohsen Reisi
Shahrokh Mirlohi
Farhad Pajhang
Majid Sadeghian
Publication date
01-09-2015
Publisher
Springer India
Published in
Indian Journal of Pediatrics / Issue 9/2015
Print ISSN: 0019-5456
Electronic ISSN: 0973-7693
DOI
https://doi.org/10.1007/s12098-015-1729-z

Other articles of this Issue 9/2015

Indian Journal of Pediatrics 9/2015 Go to the issue