From the Guidelines
Nebulized adrenaline (epinephrine) can be used cautiously in a child with stridor of unknown cause, but only in a monitored healthcare setting with appropriate emergency support available. The typical dose is 0.5 ml/kg of a 1:1000 solution, as recommended by the British Thoracic Society Nebulizer Project Group 1. This treatment should be considered a temporary measure to reduce airway edema and improve breathing while determining the underlying cause and definitive treatment. Some key points to consider when using nebulized adrenaline in this context include:
- The effect is short-lived, typically lasting 1–2 hours 1
- It should not be used in children who are shortly to be discharged or on an outpatient basis 1
- Close monitoring is essential, as a "rebound effect" with worsening symptoms can occur as the medication wears off
- Potential side effects include tachycardia, hypertension, and tremors
- Concurrent administration of steroids, such as budesonide, may also reduce symptoms in the first two hours 1 If stridor persists or worsens despite treatment, urgent airway evaluation by an otolaryngologist or emergency physician is necessary, as the child may require advanced airway management.
From the FDA Drug Label
The use of this product by children should be supervised by an adult. Children under 4 years of age: ask a doctor.
The FDA drug label does not answer the question.
From the Research
Safety of Nebulized Adrenaline in Children with Stridor of Unknown Cause
- The safety of using nebulized adrenaline (epinephrine) in a child with stridor of unknown cause is not directly addressed in the provided studies 2, 3, 4, 5, 6.
- However, the studies suggest that nebulized epinephrine can be effective in treating croup, a common cause of stridor in children 4, 5, 6.
- A study published in 1999 notes that treatment of stridor should be directed at the underlying cause 3.
- Another study published in 2022 emphasizes the importance of evaluating the upper-respiratory airway in children with stridor and considering the differential diagnosis based on the location of the obstruction, age of the patient, and acuity of the symptoms 2.
- The use of nebulized epinephrine in children with croup has been shown to be associated with a transient reduction of symptoms, but the evidence does not favor its use in all cases of stridor 5.
- It is essential to establish the underlying cause of stridor before initiating treatment, as the effectiveness and safety of nebulized epinephrine may vary depending on the cause 3, 5.
Key Considerations
- The airway should be established immediately in children with severe respiratory distress 3.
- Treatment of stridor should be directed at the underlying cause 3.
- Nebulized epinephrine may be effective in treating croup, but its use in other causes of stridor is not well established 4, 5, 6.
- Further evaluation and diagnosis are necessary to determine the safety and efficacy of nebulized adrenaline in a child with stridor of unknown cause 2, 3.