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| EDITORIAL |
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| Year : 2022 | Volume
: 9
| Issue : 3 | Page : 79 |
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Inhaled magnesium sulfate in bronchiolitis: No magic bullet yet
Ankit Mehta
Department of Pediatric Critical Care, Zydus Hospitals, Ahmedabad, Gujarat, India
| Date of Submission | 25-Apr-2022 |
| Date of Acceptance | 01-May-2022 |
| Date of Web Publication | 12-May-2022 |
Correspondence Address:
Dr. Ankit Mehta
Department of Pediatric Critical Care, Zydus Hospitals, Ahmedabad, Gujarat
India
 Source of Support: None, Conflict of Interest: None
DOI: 10.4103/jpcc.jpcc_36_22
How to cite this article:
Mehta A. Inhaled magnesium sulfate in bronchiolitis: No magic bullet yet. J Pediatr Crit Care 2022;9:79 |
Bronchiolitis is the common cause of respiratory illness across every pediatric inpatient unit. Dealing with infants and toddlers during bronchiolitis can be frustrating as most of them respond poorly to available symptomatic medications.[1] Most of the guidelines do not support use of inhaled hypertonic saline, bronchodilators, and inhaled and systemic steroids. Despite years of research, only humidified oxygen and hydration has been found to be useful till now.
It is fairly difficult to see infants with moderate-to-severe bronchiolitis struggle to breathe at bedside. To alleviate the symptoms, we keep on looking at options.
In this issue of the Journal of Pediatric Critical Care, authors have looked prospectively into inhaled magnesium sulfate for children aged 1–24 months with moderate bronchiolitis.[2] They have used nebulized magnesium sulfate 150 mg with normal saline, two doses 30 min apart, and have observed improvement for clinical severity score at 4 h. Nebulized magnesium sulfate has been found useful in cases of asthma whose pathophysiology closely mimics bronchiolitis. Magnesium acts by inhibiting the contraction of smooth muscles, acetylcholine release, and histamine release in patients of asthma. Authors have looked at clinical severity score with follow-up for the first 4 h and side effects of magnesium sulfate in a meticulous manner. They have shown significant improvement at 1 and 4 h of assessment in children with nonhypoxia group, but children with hypoxia group did not show improvement.
Similar trials are available in children under 2 years of age with nebulized magnesium sulfate from Turkey and India.[3],[4] Trials from Turkey (combination of nebulized magnesium, magnesium, and salbutamol and saline) and India (randomized control trial) have shown similar improvement in children with mild-to-moderate bronchiolitis. Recent Cochrane review suggests that we need more high-quality data on dose and efficacy of nebulized magnesium sulfate.[5] Addition of current studies will add further addition to the available data.
Mean duration for illness-like bronchiolitis is 4–10 days. Most of them can get worsening within 24–96 h of onset of illness. The current study looked at first 4 h of intervention which may not optimal end point to find out efficacy of magnesium sulfate. As mucosal edema and sloughing continues to occurs over few days in bronchiolitis, only four hours of period of observation is unlikely to help managing such children.
In the nut shell, we still do not have a definite intervention which may sure shot helpful in children with moderate bronchiolitis except humidified oxygen. Nebulized magnesium sulfate may be tried to reduce work of breathing for few hours.
| References | |  |
| 1. | Bakey A, Fouda EM, Hussein SM, Sobeih AA, Abd Al Razek AM, Hassanain AI, et al. Bronchiolitis Diagnosis, Treatment, and Prevention in Children: An Evidence-Based Clinical Practice Guideline Adapted for the Use in Egypt Based on the 'Adapted ADAPTE' Methodology Egyptian Pediatric Association Gazette; 2022.  |
| 2. | Guruprasad N, Mithra CA, Ratageri VH. Efficacy of nebulised magnesium sulphate in moderate bronchiolitis. J Pediatr Crit Care 2022;9:90-4. [Full text] |
| 3. | Kose M, Ozturk MA, Poyrazoğlu H, Elmas T, Ekinci D, Tubas F, et al. The efficacy of nebulized salbutamol, magnesium sulfate, and salbutamol/magnesium sulfate combination in moderate bronchiolitis. Eur J Pediatr 2014;173:1157-60. |
| 4. | Modaresi MR, Faghihinia J, Kelishadi R, Reisi M, Mirlohi S, Pajhang F, et al. Nebulized magnesium sulfate in acute bronchiolitis: A randomized controlled trial. Indian J Pediatr 2015;82:794-8. |
| 5. | Chandelia S, Kumar D, Chadha N, Jaiswal N. Magnesium sulphate for treating acute bronchiolitis in children up to two years of age. Cochrane Database Syst Rev 2020;12:CD012965. |
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