Review question

Is hypertonic saline solution via nebuliser effective and safe for the treatment of infants with acute bronchiolitis, compared to normal saline solution?

Background

Acute bronchiolitis is the most common lower respiratory tract infection in children aged up to two years. Bronchiolitis occurs when small structures (bronchioles) leading to the lungs become infected, causing inflammation, swelling, and mucus production. This makes breathing difficult, especially in very young children, who develop coughs and wheezing.

Because bronchiolitis is usually caused by a virus, drug treatment is usually not effective. Hypertonic saline (sterile salt water solution) breathed in as a fine mist using a nebuliser may help relieve wheezing and breathing difficulty.

We compared nebulised hypertonic (≥ 3%) saline solution with nebulised normal (0.9%) saline for infants with acute bronchiolitis.

This is an update of a review previously published in 2008, 2010, and 2013.

Search date

11 August 2017

Study characteristics

We identified 26 new studies in this update, of which 9 await assessment and 17 trials (N = 3105) were added. We included a total of 28 trials involving 4195 infants with acute bronchiolitis.

Key results

Nebulised hypertonic saline may reduce hospital stay by 10 hours in comparison to normal saline for infants admitted with acute bronchiolitis. We found that ‘clinical severity scores’, which are used by doctors to assess patient health, for children treated as outpatients or in hospital improved when administered nebulised hypertonic saline compared to normal saline. Nebulised hypertonic saline may also reduce the risk of hospitalisation by 14% among children treated as outpatients or in the emergency department. We found only minor and spontaneously resolved adverse effects from the use of nebulised hypertonic saline when given with treatment to relax airways (bronchodilators).

Reductions in hospital stay were smaller than previously thought. However, an average reduction of 10 hours in the length of hospital stay for infants is significant because bronchiolitis usually has a short duration. Nebulised hypertonic saline appears to be safe and widely available at low cost.

Quality of evidence

The quality of the evidence was low to moderate: there were inconsistencies in results among trials and risk of bias in some trials. Future large trials are therefore needed to confirm the benefits of nebulised hypertonic saline for children with bronchiolitis treated as outpatients and in hospital.