Salbutamol Nebulization Dosing for Infants

Initial Treatment and Dosing

• The American Thoracic Society recommends a dose of 2.5 mg salbutamol diluted in 2-3 mL normal saline for a 1-month-old infant, administered every 20 minutes for up to 3 doses during acute bronchospasm, then every 1-4 hours as needed 1, 2
• The initial dose can be administered via oxygen-driven nebulizer at 6-8 L/min flow rate when possible, using a face mask since infants cannot tolerate mouthpieces 2, 3, 4

Administration Technique and Safety

• The face mask should fit snugly over the nose and mouth, with a minimum dilution of 3 mL total volume and gas flow of 6-8 L/min 2, 3, 4
• Monitoring for tachycardia, tremor, and other beta-adrenergic side effects is necessary, as well as monitoring oxygen saturation, respiratory rate, and work of breathing 2

Severe Bronchospasm Protocol

• If there is an inadequate response after 3 doses at 20-minute intervals, consider adding ipratropium bromide 250 mcg every 20 minutes for 3 doses 2, 3
• Continuous nebulization may be considered for very severe attacks but requires intensive care monitoring 4