Abstract
BackgroundAcute bronchiolitis is the commonest cause of hospitalisation in infancy. Currently management consists of supportive care and oxygen. A Cochrane review concluded that, “nebulised 3 % saline may significantly reduce the length of hospital stay”. We conducted a systematic review of controlled trials of nebulised hypertonic saline (HS) for infants hospitalised with primary acute bronchiolitis.MethodsSearches to January 2015 involved: Cochrane Central Register of Controlled Trials; Ovid MEDLINE; Embase; Google Scholar; Web of Science; and, a variety of trials registers. We hand searched Chest, Paediatrics and Journal of Paediatrics on 14 January 2015. Reference lists of eligible trial publications were checked. Randomised or quasi-randomised trials which compared HS versus either normal saline (+/− adjunct treatment) or no treatment were included. Eligible studies involved children less than 2 years old hospitalised due to the first episode of acute bronchiolitis. Two reviewers extracted data to calculate mean differences (MD) and 95 % Confidence Intervals (CIs) for length of hospital stay (LoS—primary outcome), Clinical Severity Score (CSS) and Serious Adverse Events (SAEs). Meta-analysis was undertaken using a fixed effect model, supplemented with additional sensitivity analyses. We investigated statistical heterogeneity using I2. Risk of bias, within and between studies, was assessed using the Cochrane tool, an outcome reporting bias checklist and a funnel plot.ResultsFifteen trials were included in the systematic review (n = 1922), HS reduced mean LoS by 0.36, (95 % CI 0.50 to 0.22) days, but with considerable heterogeneity (I2 = 78 %) and sensitivity to alternative analysis methods. A reduction in CSS was observed where assessed [n = 516; MD −1.36, CI −1.52, −1.20]. One trial reported one possible intervention related SAE, no other studies described intervention related SAEs.ConclusionsThere is disparity between the overall combined effect on LoS as compared with the negative results from the largest and most precise trials. Together with high levels of heterogeneity, this means that neither individual trials nor pooled estimates provide a firm evidence-base for routine use of HS in inpatient acute bronchiolitis.Electronic supplementary materialThe online version of this article (doi:10.1186/s12890-015-0140-x) contains supplementary material, which is available to authorized users.
Highlights
Acute bronchiolitis is the commonest cause of hospitalisation in infancy
Details of all excluded trials at the full stage can be found in Additional file 5
Study characteristics The remaining 18 trials were conducted in: Italy (n = 106) [62]; United Arab Emirates and Canada (n = 91) [20]; China (n = 205) [63, 64]; Israel (n = 93) [18, 19]; Argentina (n = 82) [25]; India (n = 388) [65,66,67]; Qatar (n = 171) [68]; Georgia (n = 42) [69]; The Netherlands (n = 247) [70]; USA (n = 190) [71]; Turkey (n = 69) [27]; Mexico (n = unknown) [26]; Nepal (n = 59) [72] and UK (n = 290) [73] (Additional file 6)
Summary
Acute bronchiolitis is the commonest cause of hospitalisation in infancy. Management consists of supportive care and oxygen. A Cochrane review concluded that, “nebulised 3 % saline may significantly reduce the length of hospital stay”. We conducted a systematic review of controlled trials of nebulised hypertonic saline (HS) for infants hospitalised with primary acute bronchiolitis. Acute bronchiolitis is the most common cause for hospitalisation in infancy and childhood, with 1–3 % of all infants admitted to hospital during their first winter [1,2,3,4,5,6,7,8,9]. Current management involves supportive care, minimal handling, supplemental oxygen and fluids [4, 14,15,16]. The course of the illness or length of hospital stay has not been impacted by treatments including oral and inhaled steroids, antiviral agents and a variety of bronchodilators
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