Abstract
BackgroundInhaled hypertonic saline (HS) has shown benefit in decreasing airway edema in acute bronchiolitis which is the most common lower respiratory infection resulting in dyspnea among infants under 2 years old. The aim of this systematic review and meta-analysis was to evaluate the efficacy and safety of HS in the implementation of treatment with nebulized HS among children with bronchiolitis.MethodsA systematic literature search was conducted using Cochrane Library, PubMed, EMBASE and Airiti Library (Chinese Database) for randomized controlled trials from inception to July 2019. We calculated pooled risk ratios (RR), mean difference (MD) and 95% CI using RevMan 5.3 for meta-analysis.ResultsThere were 4186 children from 32 publications included. Compared to the control group, the HS group exhibited significant reduction of severity of respiratory distress, included studies used the Clinical Severity Score (n = 8; MD, − 0.71; 95% CI, − 1.15 to − 0.27; I2 = 73%) and full stop after Respiratory Distress Assessment Instrument (n = 5; MD, − 0.60; 95% CI, − 0.95 to − 0.26; I2 = 0%) for evaluation respectively. Further, the HS group decreased the length of hospital stay 0.54 days (n = 20; MD, − 0.54; 95% CI, − 0.86 to − 0.23; I2 = 81%).ConclusionsWe conclude that nebulization with 3% saline solution is effective in decreasing the length of hospital stay and the severity of symptoms as compared with 0.9% saline solution among children with acute bronchiolitis. Further rigorous randomized controlled trials with large sample size are needed.
Highlights
Inhaled hypertonic saline (HS) has shown benefit in decreasing airway edema in acute bronchiolitis which is the most common lower respiratory infection resulting in dyspnea among infants under 2 years old
Literature search results In total, 1423 articles were found in the databases, and 3 articles were manually searched; 1033 articles remained after 393 duplicate articles were excluded; 859 articles were excluded after the titles and abstract were incompatible with the study; and 174 articles were included for careful examination of the full texts
32 randomized controlled trials (RCTs) [8, 27, 28, 30,31,32,33,34,35,36,37,38,39,40,41,42,43,44,45,46,47,48,49,50,51,52,53,54,55,56,57,58] along with 31 studies were included in the meta-analysis
Summary
Inhaled hypertonic saline (HS) has shown benefit in decreasing airway edema in acute bronchiolitis which is the most common lower respiratory infection resulting in dyspnea among infants under 2 years old. Bronchiolitis is the most common lower-respiratory infection in infants, affecting 68.8% of infants and neonates aged < 12 months [1, 2], and is a major cause of hospitalization in children during the first year of life [3, 4]. According to the 2014 American Academy of Pediatrics Bronchiolitis guideline, the primary treatment method is supportive, such as rest, maintain nutrition intake and fluid supplementation [17, 18]. For symptoms such as cough and fever, the use of supportive medications such as antitussive syrup, antipyretics or nebulizer can help relieve the symptoms [18,19,20]
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