Does Normal Saline Have Clinical Effects in Infants with Bronchiolitis?

Abstract

The objective of this systematic review and meta-analysis was to measure the short-term association of nebulized normal saline with physiologic measures of respiratory status in children having bronchiolitis by comparing nebulized normal saline with the use of other placebos. Randomized clinical trials comparing children 2 years or younger with bronchiolitis who were treated with nebulized normal saline were included. Studies enrolling a treatment group receiving an alternative placebo were included for comparison of normal saline with other placebos. Pooled estimates of the association with respiratory scores, respiratory rates, and oxygen saturation within 60 minutes of treatment were generated for nebulized NS vs another placebo and for change before and after receiving nebulized normal saline. A total of 29 studies including 1583 patients were included. Standardized mean differences in respiratory scores for nebulized normal saline vs other placebo (3 studies) favored nebulized NS by–0.9 points (95% CI,–1.2 to–0.6 points) at 60 minutes after treatment (P<0.001). The standardized mean difference in respiratory score (25 studies) after nebulized NS was–0.7 (95% CI,–0.7 to–0.6; I2 = 62%). The weighted mean difference in respiratory scores using a consistent scale (13 studies) after nebulized NS was–1.6 points (95% CI,–1.9 to–1.3 points; I2 = 72%). The weighted mean difference in respiratory rate (17 studies) after nebulized NS was–5.5 breaths per minute (95%CI,–6.3 to–4.6 breaths per minute; I2 = 24%). The weighted mean difference in oxygen saturation (23 studies) after nebulized NS was–0.4% (95% CI,–0.6%to–0.2%; I2 = 79%). The authors concluded that nebulized normal saline may be an active treatment for acute viral bronchiolitis and recommended that further evaluation should occur to establish whether it is a true placebo.