What is the recommended dosage and administration of albuterol (salbutamol) for a 6-month-old infant with respiratory issues such as asthma or wheezing?

Albuterol Dosing for a 6-Month-Old Infant

For a 6-month-old infant with wheezing or respiratory distress, administer albuterol via nebulizer at 0.15 mg/kg (minimum dose 2.5 mg) every 20 minutes for 3 doses, then 0.15-0.3 mg/kg every 1-4 hours as needed, or alternatively use an MDI with valved holding chamber and face mask delivering 4-8 puffs every 20 minutes for 3 doses. 1

Dosing Algorithms Based on Severity

Mild-to-Moderate Exacerbation

• Nebulizer route: 0.15 mg/kg (minimum 2.5 mg) every 20 minutes for 3 doses 1
• MDI route: 4-8 puffs (90 mcg/puff) via valved holding chamber with face mask every 20 minutes for 3 doses 1
• After initial 3 doses, continue every 1-4 hours as needed based on clinical response 1
• MDI with spacer is equally effective as nebulization when proper technique is used 1, 2

Severe Exacerbation

• Continue albuterol at same weight-based dosing but increase frequency to every 15-30 minutes or consider continuous nebulization 1
• Add ipratropium bromide 0.25-0.5 mg to nebulizer every 20 minutes for 3 doses 1
• Administer oxygen to maintain SaO2 ≥92% 1
• Give systemic corticosteroids (prednisolone 1-2 mg/kg/day, maximum 60 mg) 1

Administration Technique

For Nebulizer

• Dilute aerosols to minimum of 3 mL at gas flow of 6-8 L/min 1
• Can mix albuterol with ipratropium in same nebulizer 1
• Deliver via face mask for infants 1

For MDI with Spacer

• Must use valved holding chamber (spacer) with face mask for children under 4 years 1, 3
• This delivery method is as effective as nebulization with proper technique 1, 2
• Research demonstrates 50 mcg/kg doses via spacer are equivalent to 150 mcg/kg via nebulizer 2
• Parents find spacer administration easier and better tolerated by infants 2

Clinical Monitoring

Assess at 15-30 Minutes Post-Treatment

• Improvement in wheezing and accessory muscle use 1, 4
• Decreased respiratory rate 1, 5
• Oxygen saturation improvement (maintain >92%) 1, 4
• Reduced work of breathing 4

Expected Response

• Studies show significant improvement in wheezing scores and retraction scores in infants 1-18 months receiving albuterol 6
• Mean improvement of 48-50% in symptom scores after cumulative dosing 7
• Oxygen saturation typically increases 0.7-0.8% after two doses 5

Safety Considerations

Common Side Effects

• Mild tachycardia (heart rate increase of approximately 8 beats/minute) 5
• Transient oxygen desaturation 8
• Tremors 8
• These effects are generally well-tolerated in infants 7, 5

Monitoring Parameters

• Heart rate and rhythm 1, 7
• No significant hypokalemia or QTc prolongation occurs with standard dosing 7
• Rare ventricular ectopy reported but clinically insignificant 7

Critical Pitfalls to Avoid

• Do not use MDI without a valved holding chamber and face mask in infants - delivery will be inadequate 1
• Do not delay systemic corticosteroids in severe exacerbations - give early if no immediate response to albuterol 1
• Do not use ipratropium as monotherapy - it should only be added to albuterol in severe cases 1
• Do not continue ineffective therapy - if no improvement after 15-30 minutes, escalate treatment and consider transfer to intensive care 1

When to Escalate Care

Transfer to intensive care if: 1

• Deteriorating clinical status despite treatment
• Persistent hypoxia (SaO2 <92% on oxygen)
• Exhaustion, confusion, or decreased level of consciousness
• Respiratory arrest or impending respiratory failure

Follow-Up

• Reassess within 24-48 hours to evaluate response 4
• Schedule follow-up with primary care provider within 1 week 1
• Consider initiating inhaled corticosteroid controller therapy if recurrent symptoms 1, 4