NEBULIZED HYPERTONIC SALINE SOLUTION FOR ACUTE BRONCHIOLITIS IN CHILDREN: A META-ANALYSIS

Objective To assess the effects of nebulized hypertonic saline solution in infants with acute viral bronchiolitis. Methods The Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, EMBASE and LILACS were searched. Studies were included if they were controlled clinical trials using nebulized hypertonic saline as an active intervention in infants up to 24 months of age with acute bronchiolitis. The weighted mean difference (WMD) and 95% confidence intervals (95% CI) were calculated to estimate the pooled treatment effect. Results Four trials involving 254 infants with acute viral bronchiolitis (189 inpatients and 65 outpatients) were included for this meta-analysis. Patients treated with nebulized 3% saline had a significant shorter mean length of hospital stay compared to those treated with nebulized 0.9% saline (WMD −0.94 days, 95% CI −1.48 to −0.40, p = 0.0006). The 3% saline group had also a significant lower post-inhalation clinical score than that in the 0.9% saline group in the first three days of treatment (day 1: WMD −0.75, 95% CI −1.38 to −0.12, p = 0.02; day 2: WMD −1.18, 95% CI −1.97 to −0.39, p = 0.003, day 3: WMD −1.28, 95% CI −2.57 to 0.00, p = 0.05). The effect size of nebulized hypertonic saline in improving clinical score was greater among outpatients than among inpatients. No adverse events related to 3% saline inhalation were reported. Conclusions Current evidence suggests nebulized 3% saline may significantly reduce the length of hospital stay and improve clinical severity score in infants with acute viral bronchiolitis.