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Nebulised hypertonic saline solution for acute bronchiolitis in infants.

Linjie Zhang1, Raúl Andrés Mendoza-Sassi1, Claire E Wainwright2

  • 1Faculty of Medicine, Federal University of Rio Grande, Rio Grande, Brazil.

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Area of Science:

  • Pediatric respiratory medicine
  • Critical care
  • Evidence-based medicine

Background:

  • Acute viral bronchiolitis in infants is characterized by airway edema and mucus plugging.
  • Nebulized hypertonic saline (≥ 3%) is investigated for its potential to alleviate these pathological changes and reduce airway obstruction.

Purpose of the Study:

  • To assess the efficacy and safety of nebulized hypertonic saline in infants diagnosed with acute bronchiolitis.

Main Methods:

  • Systematic review and meta-analysis of randomized controlled trials (RCTs) and quasi-RCTs.
  • Inclusion criteria: infants under 24 months with acute bronchiolitis, treated with nebulized hypertonic saline versus 0.9% saline or standard care.
  • Primary outcomes: length of hospital stay (inpatients) and rate of hospitalization (outpatients/ED patients).

Main Results:

  • Nebulized hypertonic saline may reduce length of hospital stay by approximately 0.40 days (low-certainty evidence).
  • It may also decrease clinical severity scores in the first three days of treatment (low-certainty evidence).
  • A 13% reduction in hospitalization risk was observed for outpatients and ED patients (low-certainty evidence).
  • No significant reduction in 28-day readmission rates was found (low-certainty evidence).
  • Resolution of wheezing, cough, and crackles showed very low-certainty evidence for improvement.
  • Adverse events were mostly mild and self-resolving, particularly when co-administered with bronchodilators (low-certainty evidence).

Conclusions:

  • Nebulized hypertonic saline offers a modest benefit in reducing hospital stay duration and improving clinical scores for hospitalized infants with bronchiolitis.
  • It may also decrease hospitalization rates for outpatients and emergency department patients.
  • The treatment appears safe, with minor adverse events, especially when combined with bronchodilators.
  • The overall certainty of the evidence for these outcomes is low to very low, necessitating cautious interpretation.