Hypertonic saline (HS) for acute bronchiolitis: Systematic review and meta-analysis

Area of Science:

• Pediatrics
• Respiratory Medicine
• Evidence-Based Medicine

Background:

• Acute bronchiolitis is a leading cause of infant hospitalization.
• Current management relies on supportive care and oxygen.
• Nebulised 3% saline has shown potential to shorten hospital stays.

Purpose of the Study:

• To systematically review controlled trials of nebulised hypertonic saline (HS) for hospitalized infants with acute bronchiolitis.
• To assess the impact of HS on length of hospital stay, clinical severity, and adverse events.

Main Methods:

• Systematic review of randomized or quasi-randomized trials comparing HS with normal saline or no treatment.
• Searches conducted across multiple databases up to January 2015.
• Meta-analysis used a fixed effect model; heterogeneity assessed using I².

Main Results:

• Fifteen trials (n=1922) indicated HS reduced mean length of stay by 0.36 days, but with significant heterogeneity (I²=78%).
• A reduction in Clinical Severity Score was observed (MD -1.36, CI -1.52 to -1.20).
• Only one trial reported a possible intervention-related serious adverse event.

Conclusions:

• Discrepancies exist between overall pooled effects and precise trial results.
• High heterogeneity and conflicting data preclude a firm evidence base for routine HS use in inpatient acute bronchiolitis.
• Further research may be needed to clarify the role of hypertonic saline.