NEBULIZED HYPERTONIC SALINE SOLUTION FOR ACUTE BRONCHIOLITIS IN INFANTS
Linjie Zhang1, Raúl A Mendoza-Sassi2, Claire Wainwright3, Terry P Klassen4
1Department of Maternal and Child Health, Federal University of Rio Grande, Rio Grande, RS, Brazil. 2Department of Internal Medicine, Federal University of Rio Grande, Rio Grande, RS, Brazil. 3Department of Respiratory Medicine, Royal Children’s Hospital, Brisbane, Australia. 4Department of Pediatrics, Aberhart Centre One, Room 8213, Edmonton, Canada
Airway edema and mucus plugging are the predominant pathological features in infants with acute viral bronchiolitis. Nebulized hypertonic saline solution may reduce these pathological changes and decrease airway obstruction.
To assess the effects of nebulized hypertonic saline solution in infants with acute viral bronchiolitis.
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2007, issue 4), which contains the Cochrane Acute Respiratory Infections Group Specialized Register; OLDMEDLINE (1951 to 1965); MEDLINE (1966 to November 2007); EMBASE (1974 to November 2007); and LILACS (November 2007).
Randomised controlled trials (RCTs) and quasi-RCTs using nebulized hypertonic saline alone or in conjunction with bronchodilators as an active intervention in infants up to 24 months of age with acute bronchiolitis.
Data collection and analysis
Two review authors (ZL, MRA) independently performed data extraction and study quality assessment. We pooled the data from individual trials using the Cochrane statistical package Review Manager (RevMan).
We included four trials involving 254 infants with acute viral bronchiolitis (189 inpatients and 65 outpatients) in this review.
Patients treated with nebulized 3% saline had a significantly shorter mean length of hospital stay compared to those treated with nebulized 0.9% saline (mean difference (MD) -0.94 days, 95% CI -1.48 to -0.40, P = 0.0006).
The 3% saline group also had a significant lower post-inhalation clinical score than the 0.9% saline group in the first three days of treatment (day 1: MD -0.75, 95% CI -1.38 to -0.12, P = 0.02; day 2: MD -1.18, 95% CI -1.97 to -0.39, P = 0.003; day 3: MD -1.28, 95% CI -2.57 to 0.00, P = 0.05). The effect of nebulized hypertonic saline in improving clinical score was greater among outpatients than inpatients. No adverse events related to 3% saline inhalation were reported.
Current evidence suggests nebulized 3% saline may significantly reduce the length of hospital stay and improve the clinical severity score in infants with acute viral bronchiolitis.