• Hospitalization Rate [ Time Frame: After two treatments in the emergency department ] [ Designated as safety issue: No ]
  

• The IRAS (Infant Respiratory Assessment Score) will be measured after each Treatment to verify improvement. [ Time Frame: 30,60,90 and 120 min ] [ Designated as safety issue: No ]
  

Acute Viral Bronchiolitis (AVB) is the principal infectious disease of the lower respiratory track in infants worldwide. It affects 20% of Noth-American infants every winter season, 6.2% require treatment in the ER and between 3 to 5% of them require hospitalization or ICU stay. Although the mortality rate has remained constant in the passed 10 years, the incidence in North-America has increased by a factor of 3.

AVB is clinically characterized by an episode of difficult breathing, increase of respiratory work, presence of wheezing, crackles, signs of upper respiratory track infection, and fever (Rectal temperature >38DC). The currently accepted treatment (Adequate hydration, supplementary oxygen and cleaning of upper respiratory secretions) remains as non-controversial, even though many research studies have tried to prove the efficacy of other substances. Epinephrine and Hypertonic saline have shown to be potentially effective treatments for AVB.

We are proposing a multicenter randomized double blind clinical essay, in patients who will assist to the emergency department of 5 Hospital Centers in Quebec Canada, between October 2009 thru April 2012, and are diagnosed with AVB by the following criteria (first moderate episode of sudden difficulty to breathe and signs and symptoms of upper respiratory track infection plus fever). Patients will be separated into 4 groups: Nebulized epinephrine and hypertonic saline solution (NaCl 3%), Nebulized epinephrine and Physiologic Saline solution (NaCl 0.9%),Nebulized hypertonic saline solution (NaCl 3%),and nebulized physiologic saline solution (NaCl 0.9%). Each group will receive a treatment of 3 nebulizations in the fist 4 hours of ER stay and their respiratory distress signs will be measured using various clinical scores.

The principal objective is to compare the efficacy of different groups of treatment for reducing hospitalization rate. And our secondary principal objective is to compare between groups of treatment the intensity of symptoms measured by the Infant Respiratory Assessment Score, which has been validated.

We will also measure time from discharge of the ER. The presence of secondary effects. The rate of transfers from ER to Pediatric Intensive Care Unit. The intensity of symptoms 7 days after treatment. The number of times the patient comes back seeking medical care within the first 28 days of their first episode of AVB, and hospitalization rate of recurrent patients.

The evaluation of the efficacity of epinephrine or hypertonic saline, in the treatment of AVB, is very important in order to improve the respiratory condition in our patients. To avoid unnecessary hospitalizations and thus improve the quality of life of the patient, and that of their parents; optimizing at the same time hospital resources.

Inclusion Criteria:

• clinical diagnosis of viral bronchiolitis
• Age 0 to 18 months
• Clinical Score IRAS >3 and <8

Exclusion Criteria:

• prematurity <30 weeks
• chronic lung disease
• immunosuppression.
• History of wheezing or asthma.
• Clinical Score IRAS >9
• parents refuse study