Can I give salbutamol (albuterol) to infants?

Salbutamol Use in Infants

Salbutamol should be restricted to symptomatic infants with obvious bronchospasm, and is not recommended for routine use in all infants due to variable response and potential side effects. 1

Efficacy in Different Infant Populations

• Salbutamol has shown variable effectiveness in infants, with response primarily dependent on symptom status and presence of lung function abnormalities 1
• In symptomatic preterm infants, nebulized salbutamol can reduce airway resistance by approximately 25% and improve specific airway conductance 2
• Asymptomatic preterm infants typically show no significant improvement in lung function with salbutamol administration 2
• For infants with bronchiolitis, salbutamol has not demonstrated clinical benefit and can lead to side effects such as increased heart rate and respiratory rate 3

Dosing Recommendations

• For symptomatic infants requiring treatment:
  • Via metered-dose inhaler (MDI) with spacer: 200 μg of salbutamol has shown improvements in compliance and resistance, while a lower dose of 100 μg may not be universally effective 1
  • Via nebulizer: 2.5 mg for children weighing less than 20 kg, 5 mg for children weighing more than 20 kg 4, 5

Administration Methods

• MDI with spacer is the preferred delivery method for salbutamol in infants because: 1
  • It takes less time to administer
  • Does not require ventilator flow adjustment
  • Avoids cooling of gases
  • Prevents paradoxical deterioration in airway resistance seen with nebulization
• A face mask should be used with either MDI or nebulizer to ensure optimal drug delivery 1

Special Considerations

• For infants under age 6 with upper respiratory infections requiring anesthesia, nebulized salbutamol (2.5 mg for <20 kg, 5 mg for >20 kg) administered 30 minutes before induction can reduce perioperative respiratory complications by approximately 50% 1, 5
• In ventilated infants with chronic lung disease, repeated doses of salbutamol have been associated with improvements in static compliance, but trials have not demonstrated long-term outcome benefits 1

Monitoring and Side Effects

• Monitor heart rate, respiratory rate, and oxygen saturation when administering salbutamol to infants 4
• Potential side effects include:
  • Tachycardia (especially with intravenous administration) 1
  • Increased respiratory rate 3
  • Hypokalemia 6

Clinical Decision Algorithm

1. Assess for symptoms of bronchospasm (wheezing, prolonged expiratory phase, use of accessory muscles) 1
2. If symptoms present:
   • Start with MDI plus spacer and face mask (200 μg per dose) 1
   • Alternatively, use nebulized salbutamol (2.5 mg for infants <20 kg) 4, 5
3. Monitor response:
   • If positive response (decreased work of breathing, improved oxygen saturation), continue treatment as needed 1
   • If no response or worsening, consider alternative therapies 1
4. For infants with chronic lung disease, restrict therapy to symptomatic patients with obvious bronchospasm 1

Important Caveats

• The safety and effectiveness of salbutamol inhalation aerosol in children below 4 years have not been established according to FDA labeling 6
• Response to bronchodilators in infants is variable, and infant lung function testing may help identify those likely to benefit from treatment 1
• For infants with bronchiolitis, current evidence does not support routine use of salbutamol 3
• In wheezy infants with an atopic background, salbutamol has not shown significant beneficial effects on either clinical symptoms or pulmonary function 7