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Hypertonic saline inhalations in bronchiolitis-A cumulative meta-analysis.

Paula Heikkilä1, Marjo Renko1,2, Matti Korppi1

  • 1Tampere Centre for Child Health Research, University of Tampere and Tampere University Hospital, Tampere, Finland.

Pediatric Pulmonology
|December 22, 2017
PubMed
Summary

Hypertonic saline (HS) inhalations in infants with bronchiolitis showed statistically significant, but limited, clinical benefits in reducing hospital length of stay and outpatient hospitalization rates. However, substantial heterogeneity was observed across studies.

Keywords:
bronchiolitisefficacyhypertonic salinemeta-analysisnormal saline

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Area of Science:

  • Pediatric Respiratory Medicine
  • Evidence-Based Medicine
  • Clinical Trials Analysis

Background:

  • Bronchiolitis is a common viral respiratory infection in infants.
  • Current treatments for bronchiolitis are largely supportive.
  • Hypertonic saline (HS) is explored as a potential therapeutic agent.

Purpose of the Study:

  • To perform a cumulative meta-analysis on the efficacy of hypertonic saline (HS) inhalations in children with bronchiolitis.
  • To compare HS inhalations against normal saline or no inhalations as controls.
  • To evaluate the impact of HS on length of hospital stay and hospitalization rates.

Main Methods:

  • Cumulative meta-analysis of published randomized controlled trials.
  • Literature search of PubMed, Scopus, and hand searches until June 2017.
  • Inclusion criteria: children <24 months with bronchiolitis, randomized controlled trials of HS inhalations.
  • Outcomes assessed: length of stay (LOS) using mean difference (MD) and hospitalization rate using risk ratio (RR).

Main Results:

  • Eighteen studies with 2102 hospitalized children showed a cumulative MD in LOS of -0.471 days (95% CI -0.765 to -0.177) with substantial heterogeneity (I²=72.9%).
  • In outpatient settings, eight studies with 1834 children showed a cumulative RR for hospitalization of 0.771 (95% CI 0.619-0.959) with moderate heterogeneity (I²=55.8%).
  • Reduced heterogeneity and smaller effect sizes were observed in more recent studies and those with a low risk of bias.

Conclusions:

  • Hypertonic saline inhalations demonstrate statistically significant but clinically limited benefits in bronchiolitis management.
  • Substantial heterogeneity across studies necessitates caution in interpreting results.
  • Further research with standardized definitions and comparable methodologies is warranted.