Late Breaking Abstract - Can newborns with bronchiolitis effectively use a metered-dose inhaler with spacer?

<bold>Background:</bold> Bronchiolitis, a common lung infection in infants, is mainly caused by RSV. Supportive treatment seems adequate in the majority of children. According to some recommendations, treatment with bronchodilators may be attempted, which can be administered, among others, using a metered-dose inhaler (MDI) in combination with valved holding chamber. <bold>Objective:</bold> To assess whether neonates can generate sufficient inspiratory flow to open the one-way (inspiratory) valve of VHC. <bold>Methods:</bold> The study included 20 newborns, aged 21-28 days, hospitalized for RSV bronchiolitis. They were born at 38-40 weeks gestation, weighed 3000-3500g, scored at least 8 on the Apgar scale, and had no congenital malformations. Newborns' ability to open the VHC inspiratory valve three times in 10 seconds was assessed by measuring pressure in the spacer using a respiratory pressure meter (MicroRPM, Vyaire Medical, USA), which was connected to the inner chamber of VHC (AeroChamber Plus Flow-Vu, Trudell Medical International, London) through a 15 cm long silicone tube. The VHC was equipped with a fitted face mask and a drug-free MDI. The measurement was performed before starting treatment in an awake child. <bold>Results:</bold> The mean age of participants was 25 days and the mean weight was 3925g. 11 children (55%) generated a pressure in the chamber at least three times in 10 seconds, so were capable to obtained sufficient inspiratory flow to open the inspiratory valve of VHC. <bold>Conclusion:</bold> Every other newborn with bronchiolitis, aged 21-28 days is unable to generate inspiratory flow that will allow the one-way valve in the VHC to open and, therefore, take the drug from the spacer. Therefore, nebulization seems to be preferable.