Clinical Effectiveness of Nebulized Magnesium Sulfate in Pediatric Acute Asthma: A Systematic Review

Asthma is a common cause of acute illness and healthcare utilization in children, and while intravenous magnesium sulfate is established in severe exacerbations, the clinical role of nebulized magnesium sulfate remains uncertain. This systematic review evaluated whether nebulized magnesium sulfate, used as an adjunct to standard therapy, improves clinical outcomes in pediatric acute asthma exacerbations. A comprehensive literature search was conducted in accordance with the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA 2020) guidelines, identifying studies published between January 2010 and November 2025. Seven studies were included: six randomized controlled trials and one systematic review with meta-analysis, all involving pediatric populations. Study selection, data extraction, and quality appraisal were performed using validated tools, including A Measurement Tool to Assess Systematic Reviews (AMSTAR 2) and the Revised Cochrane Risk-of-Bias tool for randomised trials (RoB 2). Across the included studies, nebulized magnesium sulfate demonstrated variable and generally modest effects on asthma severity scores, with no consistent reduction in hospital admission rates, length of stay, or escalation of care. Safety findings were reassuring, with no serious treatment-related adverse events reported. Overall, current evidence does not demonstrate a clear or consistent additional clinical benefit of nebulized magnesium sulfate beyond standard therapy in pediatric acute asthma exacerbations. Future well-designed trials using standardized outcome measures and longer follow-up are required to clarify its role in contemporary pediatric asthma management.