Nebulization with hypertonic saline effective in infants with bronchiolitis

Nebulized hypertonic saline may somewhat improve the clinical severity score and shorten the length of stay in infants hospitalized with acute bronchiolitis, says an article published in the Cochrane Database of Systematic Reviews.

In babies with acute viral bronchiolitis, airway edema (swelling) and mucus clogging are the main pathogenic characteristics. These pathological alterations and airway blockage may be lessened by inhaling a hypertonic saline solution ( 3%) solution. This review was originally published in 2008 and has since been updated in 2010, 2013, and 2017. In order to determine the effects of nebulized hypertonic ( 3%) saline solution in babies with acute bronchiolitis, Linjie Zhang and team carried out this investigation.

On January 13, 2022, searches were conducted for Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE Epub Ahead of Print, MEDLINE, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily, LILACS, Embase, CINAHL, and Web of Science. Children under 24 months old with acute bronchiolitis were included in randomized controlled trials (RCTs) and quasi-RCTs that used nebulized hypertonic saline alone or in combination with bronchodilators as an active intervention and nebulized 0.9% saline or normal care as a comparator. Length of hospital stay was the main result of inpatient trials, whereas rate of hospitalization was the main result of outpatient or emergency department (ED) trials.

The key findings of this study were:

1. Compared to infants treated with nebulized normal (0.9%) saline or standard care, hospitalized infants treated with nebulized hypertonic saline may experience a shorter mean length of hospital stay.

2. In the first three days of treatment, infants who received hypertonic saline might also have post-inhalation clinical scores that were lower than those of infants who received normal saline.

3. When compared to nebulized normal saline, nebulised hypertonic saline may reduce the chance of hospitalization by 13% in infants who were treated as outpatients or in the emergency department.

4. Up to 28 days following release, hypertonic saline may not, however, lower the likelihood of readmission to the hospital.

5. Twenty-seven trials provided safety data: 14 reported no adverse events, 13 reported at least one adverse event, the majority of which were minor and went away on their own (low certainty evidence).

6. The adverse events included worsening cough, bronchospasm, agitation, bradycardia, vomiting, desaturation, and diarrhea.

Nebulized hypertonic saline therapy may also lower outpatient and ED patients' likelihood of hospitalization. When combined with a bronchodilator, nebulized hypertonic saline appears to be a safe treatment for infants with bronchiolitis, with relatively minimal and spontaneously resolved adverse effects. Due mostly to inconsistency and the possibility of bias, the certainty of the evidence ranged from low to very low for all outcomes.

Reference:

Zhang, L., Mendoza-Sassi, R. A., Wainwright, C. E., Aregbesola, A., & Klassen, T. P. (2023). Nebulised hypertonic saline solution for acute bronchiolitis in infants. In Cochrane Database of Systematic Reviews (Vol. 2023, Issue 4). Wiley. https://doi.org/10.1002/14651858.cd006458.pub5