{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T09:09:07Z","timestamp":1789549747529,"version":"build-2803163510"},"reference-count":22,"publisher":"MDPI AG","issue":"9","license":[{"start":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T00:00:00Z","timestamp":1789516800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Children"],"abstract":"<jats:p>Background: International guidelines do not support the routine use of nebulized epinephrine for acute viral bronchiolitis. Despite its vasoconstrictive and bronchodilator properties, evidence remains inconclusive. Objectives: Day-6 fraction of inspired oxygen (FiO2) adjusted for baseline FiO2 was designated as the principal outcome; however, this outcome hierarchy was not prospectively prespecified. The analysis compared day-6 FiO2, adjusted for baseline FiO2, between nebulized racemic epinephrine and placebo; peripheral capillary oxygen saturation (SpO2), respiratory rate (RR), and heart rate (HR) were secondary outcomes. Methods: This randomized, single-blind, placebo-controlled trial included 26 infants aged 0\u201312 months with moderate-to-severe bronchiolitis requiring respiratory support. Participants were allocated 1:1 to nebulized racemic epinephrine (group A, n = 13) or isotonic saline placebo (group B, n = 13). Outcomes were measured at baseline (T0), day 3 (T1), and day 6 (T2). The primary analysis used ANCOVA to compare T2 FiO2 while adjusting for T0 FiO2; mixed repeated-measures ANOVA assessed longitudinal trajectories. Results: The adjusted T2 FiO2 difference between groups was \u22120.43 percentage points (95% CI \u22123.43 to 2.57; p = 0.772). Adjusted T2 differences were also non-significant for SpO2 (p = 0.058), RR (p = 0.093), and HR (p = 0.487). FiO2 decreased over time (p = 1.99 \u00d7 10\u22124), but the group-by-time interaction was not significant (p = 0.108); no interaction was observed for SpO2, RR, or HR (p = 0.296, p = 0.187, and p = 0.352, respectively). Conclusions: Nebulized racemic epinephrine did not improve the trajectories of oxygen requirement, SpO2, RR, or HR compared with placebo; improvements over time were observed in both groups.<\/jats:p>","DOI":"10.3390\/children13091254","type":"journal-article","created":{"date-parts":[[2026,9,16]],"date-time":"2026-09-16T07:58:59Z","timestamp":1789545539000},"page":"1254","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":0,"title":["Nebulized Epinephrine Versus Placebo in Infants with Moderate-to-Severe Bronchiolitis: A Randomized Controlled Trial"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0009-0006-7552-3932","authenticated-orcid":false,"given":"Immacolata","family":"Rulli","sequence":"first","affiliation":[{"name":"Neonatal and Pediatric Intensive Care Unit, \u201cGaetano Martino\u201d Hospital, Via Consolare Valeria 1, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"conceptualization","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7084-5605","authenticated-orcid":false,"given":"Simone","family":"Foti Randazzese","sequence":"additional","affiliation":[{"name":"Pediatric Unit, Department of Human Pathology of Adult and Childhood \u201cGaetano Barresi\u201d, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"methodology","vocabulary":"credit"},{"role":"formal-analysis","vocabulary":"credit"},{"role":"writing-original-draft","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"given":"Fabio","family":"Toscano","sequence":"additional","affiliation":[{"name":"Pediatric Unit, Department of Human Pathology of Adult and Childhood \u201cGaetano Barresi\u201d, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"software","vocabulary":"credit"},{"role":"resources","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"}]},{"given":"Lucia Marina","family":"Marseglia","sequence":"additional","affiliation":[{"name":"Neonatal and Pediatric Intensive Care Unit, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"investigation","vocabulary":"credit"},{"role":"visualization","vocabulary":"credit"},{"role":"data-curation","vocabulary":"credit"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-7664-3083","authenticated-orcid":false,"given":"Sara","family":"Manti","sequence":"additional","affiliation":[{"name":"Pediatric Unit, Department of Human Pathology of Adult and Childhood \u201cGaetano Barresi\u201d, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"visualization","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]},{"given":"Eloisa","family":"Gitto","sequence":"additional","affiliation":[{"name":"Neonatal and Pediatric Intensive Care Unit, Department of Clinical and Experimental Medicine, University of Messina, Via Consolare Valeria 1, 98124 Messina, Italy"}],"role":[{"vocabulary":"crossref","role":"author"},{"role":"visualization","vocabulary":"credit"},{"role":"validation","vocabulary":"credit"},{"role":"writing-review-editing","vocabulary":"credit"},{"role":"supervision","vocabulary":"credit"}]}],"member":"1968","published-online":{"date-parts":[[2026,9,16]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"19","DOI":"10.1186\/s13052-022-01392-6","article-title":"UPDATE\u20142022 Italian guidelines on the management of bronchiolitis in infants","volume":"49","author":"Manti","year":"2023","journal-title":"Ital. 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