Atrovent Nebulization Dosing for Children Under 2 Years
For children under 2 years old, use ipratropium bromide 100-125 mcg (half the standard pediatric dose) via nebulizer, diluted to a minimum of 3 mL total volume with normal saline for optimal nebulization. 1
Specific Dilution Instructions
- Start with 100-125 mcg of ipratropium bromide solution (this is half the standard pediatric dose of 250 mcg) 2, 1
- Dilute to a minimum total volume of 3 mL using normal saline to ensure adequate nebulization 1
- For infants with bronchopulmonary dysplasia requiring ventilation, doses as low as 75-125 mcg have been studied, with 125 mcg showing efficacy 3
- In pre-term babies, doses exceeding 20 mcg may produce side effects, so extreme caution is warranted in this population 4
Administration Protocol
Initial Treatment for Acute Wheezing/Asthma
- Administer every 20 minutes for the first 3 doses when treating acute severe asthma or wheezing 1
- Then continue every 6 hours until clinical improvement begins 2, 1
- Use an oxygen-driven nebulizer at 6-8 L/min flow rate 1
- Ensure proper pediatric mask fit to maximize medication delivery 5
Clinical Context for Use
- Add ipratropium to beta-agonist therapy (not as monotherapy) in very young children who are not improving after 15-30 minutes of initial beta-agonist treatment 2, 1
- Ipratropium can be particularly useful in the first 18 months of life when beta-2 agonists are often less effective 4
- Approximately 40% of young children with recurrent airways obstruction obtain significant benefit 4
Combination Therapy Option
- Ipratropium can be mixed with albuterol/salbutamol in the same nebulizer solution 1
- For children under 5 years using combination therapy (Duolin), use 1.5 mL of solution containing 0.25 mg ipratropium + 1.25 mg salbutamol 5
- Studies in infants under 25 months showed combination therapy (fenoterol + 50 mcg ipratropium) was significantly more effective than beta-agonist alone (63.4% vs 25.8% improvement) 6
Important Safety Considerations
- Monitor for dry mouth and respiratory secretions as common side effects 5
- Watch for paradoxical increased wheezing in some individuals 5
- In ventilated infants with BPD, doses of 125-175 mcg combined with salbutamol showed significant improvements in respiratory mechanics at 1-2 hours and 4 hours post-administration 3
- Metered-dose aerosol with spacer and mask is equally effective as nebulization in this age group and may be more convenient 7
Key Clinical Pitfalls to Avoid
- Never use ipratropium as first-line monotherapy in acute exacerbations—always combine with beta-agonists 1, 5
- Do not exceed the half-dose recommendation (100-125 mcg) in very young children, as the British Thoracic Society specifically emphasizes dose reduction for this age group 2, 1
- Ensure adequate dilution volume (minimum 3 mL) to prevent inadequate nebulization and suboptimal drug delivery 1