Comparative Efficacy of Nebulized 7% Hypertonic Saline versus 3% Hypertonic Saline in Children with Acute Bronchiolitis

Background: Acute bronchiolitis is an acute viral lower respiratory tract infection in early childhood and is the leading cause of hospitalization in infants below 2 years of age. Being a viral disease, there is no effective treatment of this problem other than supportive care. To provide this care, both 3% hypertonic saline and 7% hypertonic saline has been used and found effective. However, which option is more effective to reduce clinical severity and length of hospital stay, still remain unsettled.Objective: To determined the efficacy of 7% hypertonic saline in children with acute bronchiolitis.Methodology: The study was a randomized controlled trial and carried out in the Department of Paediatrics, Dhaka Medical College Hospital (DMCH), Dhaka between January 2015 to December 2016. A total of 135 children from 1 month to 2 years of age irrespective of sex with clinical presentation of acute bronchiolitis admitted in the paediatrics ward of DMCH were included in the study and were randomly assigned to either 7% nebulized hypertonic saline (Group-I = 45) or to 3% nebulized hypertonic saline (Group-II = 90) in ratio (1:2). The main outcome variables were clinical severity score and length of hospital stay. The outcome was evaluated at 12 hourly and 24 hourly intervals till discharge (up to 120 hours)Result: In this study both groups were almost similar with respect to their demographic characteristics like age and sex and baseline clinical characteristics. The study demonstrated that respiratory rate score, wheezing score, retraction score, general condition score and clinical severity score of both treatment modalities were reduced. Children of group-I(7% HS) 40(88.9%) recovered at the end of 72 hours where as 67(74.4%) of the children of group-II(3% HS) recovered from the disease during the same period. Length of hospital stay was shorter in 7% hypertonic saline group compared to 3% hypertonic saline group (56.36±16.33 hours vs63.07±21.48 hours, p=.067). The patients of 7% hypertonic saline group required a shorter duration of oxygen therapy compared to 3% hypertonic saline group (16.53±3.98) hours vs (20.25± 4.15) hours, (p=0.109) respectively.Conclusion: Nebulized 7% hypertonic saline as well as 3% hypertonic saline both were effective in acute bronchiolitis and found no significant difference in efficacy between these options in terms of reducing clinical severity, length of hospital stay and duration of oxygen therapy. No side effect were observed in either group.J Dhaka Medical College, Vol. 26, No.2, October, 2017, Page 153-156

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Comparative Efficacy of Nebulized 3% Hypertonic Saline versus 0.9% Normal Saline in Children with Acute Bronchiolitis

Bangladesh Journal of Child Health ◽

10.3329/bjch.v42i3.39264 ◽

2018 ◽

Vol 42 (3) ◽

pp. 130-137 ◽

Cited By ~ 1

Author(s):

Khandaker Tarequl Islam ◽

Abid Hossan Mollah ◽

Abdul Matin ◽

Mahmuda Begum

Keyword(s):

Hospital Stay ◽

Hypertonic Saline ◽

Normal Saline ◽

Severity Score ◽

Oxygen Therapy ◽

Length Of Hospital Stay ◽

Clinical Severity ◽

Acute Bronchiolitis ◽

Group I ◽

Group Ii

Background: Acute bronchiolitis is leading cause of hospitalization in infants below 2 years of age. Bronchiolitis being a viral disease, there is no effective treatment. 3% nebulized hypertonic saline and 0.9% nebulized normal saline are often used, although there is disagreement over their efficacy. The aim of this study was to evaluate the efficacy of 3% hypertonic saline in children with acute bronchiolitis in reducing clinical severity and length of hospital stay. Methodology: A randomized control trial carried out in the Department of Pediatrics, Dhaka Medical College Hospital from January 2013 to December 2013.Ninty children from 1 month to 2 years of age hospitalized with clinical bronchiolitis were randomized to receive 3% nebulized hypertonic saline(Group-I) or 0.9% nebulized normal saline (Group-II). Nebulization was done 8 hourly until discharge. Outcome variable were clinical severity score, duration of oxygen therapy and length of hospital stay. Results: Baseline clinical severity score and O2 saturation were in group-I 9.0±1.0 and 94.9±1.7 and in group- II 9.3±1.8 and 94.6±2.6 respectively (p>0.05). At 72 hours, the mean severity score for the group-I was 1.64±0.99 and that for the group-II was 3.0 ± 1.48 (95% CI -2.17 to - 0.53, p=0.002). The cases of group-I required a shorter duration of oxygen therapy compared to those of group-II (15.0±6.0 hours vs 26.4±5.37 hours, 95% CI -20.35 to -2.44, p<0.05). Forty two (93.3%) of the group-I children recovered by the end of72 hours and discharged whereas 26 (57.8%) of the group-II children recovered during the same period (p<0.05). Length of hospital stay was shorter in group-I compared to group-II (58.1±22.0 hours vs 74.7±27.2 hours, 95% CI -26.89 to- 6.17, p=0.002). None of the cases encountered any side-effects. Conclusion: Nebulization with 3% hypertonic saline significantly reduced clinical severity, length of hospital stay and duration of oxygen therapy in case of acute bronchiolitis in comparison to 0.9% normal saline and was safe. Bangladesh J Child Health 2018; VOL 42 (3) :130-137

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Comparative Efficacy of Nebulized 7% Hypertonic Saline versus 0.9% Normal Saline with Salbutamol in Children with Acute Bronchiolitis

Bangladesh Journal of Child Health ◽

10.3329/bjch.v43i2.42550 ◽

2019 ◽

Vol 43 (2) ◽

pp. 80-84

Author(s):

Md Saiful Islam ◽

Md Abid Hossain Mollah ◽

Rokeya Khanam ◽

Abu Sayeed Chowdhury ◽

Md Mahfuzur Rahman ◽

...

Keyword(s):

Hypertonic Saline ◽

Normal Saline ◽

Severity Score ◽

Length Of Hospital Stay ◽

Saline Group ◽

Clinical Severity ◽

Acute Bronchiolitis ◽

Clinical Severity Score ◽

Group I ◽

Group Ii

Background: Acute bronchiolitis is an acute viral lower respiratory tract infection of infants and is the leading cause of hospitalization of infants below 2 years of age. Being a viral disease, there is no effective treatment of this problem other than supportive care. To provide this care, both 0.9% normal saline with salbutamol and 3% hypertonic saline has been found effective. This study was undertaken to assess the efficacy of 7% hypertonic saline on recovery from acute bronchiolitis. Methodology: This was a randomized controlled trial, carried out in the Department of Paediatrics, Dhaka Medical College Hospital (DMCH), Bangladesh between January 2015 to December 2015. A total of 90 children from 1 month to 2 years of age of either sex who were diagnosed and admitted as acute bronchiolitis were enrolled. After enrollment, they were randomly assigned to either 7% nebulized hypertonic saline (Group-I = 45) or to 0.9% nebulized normal saline with salbutamol (Group-II = 45). The efficacy was determined by assessing clinical severity score and length of hospital stay. Data were analyzed using computer software SPSS version 19. Result: In this study the two groups were almost similar with respect to their demographic and baseline clinical severity score. After intervention the clinical severity score of both treatment modalities were reduced (Group-I(HS) were 7.9, 6.8, 3.8, 1.4, 1.33 while in Group-II(NS+ Salbutamol) score were 8.6, 7.6, 4.9, 3.11, 2.12) but the reduction was significant more in children who received 7% nebulized hypertonic saline than those who received 0.9% nebulized normal saline with salbutamol. Majority 42(93.3%) of group-I(HS) children recovered at the end of 72 hours whereas 17(37.8%) of the children of group-II (NS+ Salbutamol) recovered from the disease during the same period. Length of hospital stay was shorter in hypertonic saline group compared to normal saline with salbutamol group (56.36±12.33 hours vs71.07±13.48 hours, p<.001). The patients of hypertonic saline group required a shorter duration of oxygen therapy compared to normal saline with salbutamol group (12.53±3.58) hours vs (20.25± 4.15) hours, (p=0.009). Conclusion: 7% hypertonic saline was found more effective than 0.9% normal saline with salbutamol in terms of reducing clinical severity, length of hospital stays and duration of oxygen therapy. Bangladesh J Child Health 2019; VOL 43 (2) :80-84

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Hypertonic saline versus normal saline nebulization in hospitalized children with acute bronchiolitis.

The Professional Medical Journal ◽

10.29309/tpmj/2020.27.12.4667 ◽

2020 ◽

Vol 27 (12) ◽

pp. 2734-2738

Author(s):

Maleeha Saleem ◽

Maria Saleem ◽

Asim Khurshid

Keyword(s):

Hospital Stay ◽

Hypertonic Saline ◽

Normal Saline ◽

Severity Score ◽

Length Of Hospital Stay ◽

Clinical Severity ◽

Hospitalized Children ◽

Acute Bronchiolitis ◽

Group A ◽

Group B

Objectives: To compare mean length of hospital stay (LOHS) after treatment with nebulized hypertonic saline (HS) versus normal saline (NS) in hospitalized children with acute bronchiolitis (AB). Study Design: Randomized Control Trial. Setting: Department of Pediatric Medicine, The Children’s Hospital and Institute of the Child Health, Multan. Period: July 2018 to January 2019. Material & Methods: A total of 206 hospitalized children having AB were enrolled. Group A (n=103) was nebulized with 2 ml of 3 % HS while group B (n=103) was nebulized with 2 ml of 0.9% saline solution. Clinical severity score was calculated daily to monitor progress of patients. Patients were discharged from hospital with clinical severity score of 4 or less and length of hospital stay was noted. Results: Overall, mean age was 5.83±4.48 months. Among 206 patients 139 (67.5%) were males and 67 (32.5%) females. Mean duration of disease was noted to be 3.57+2.2 days. In Group-A, mean LOHS was 36.29+18.4 hours in comparison to 39.15+16.1 hours in Group B (p-value = 0.2365). Conclusion: Nebulized HS 3% and NS 0.9% were not found to have any significant advantage over each other in terms of LOHS among hospitalized children having acute bronchiolitis.

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Efficacy of nebulised L-adrenaline with 3% hypertonic saline versus normal saline in bronchiolitis

Bangabandhu Sheikh Mujib Medical University Journal ◽

10.3329/bsmmuj.v7i1.29141 ◽

2016 ◽

Vol 7 (1) ◽

pp. 15

Author(s):

Shabnam Sharmin ◽

Laila Helaly ◽

Zakir Hossain Sarker ◽

Ruhul Amin ◽

Shafi Ahmed ◽

...

Keyword(s):

Oxygen Saturation ◽

Respiratory Rate ◽

Hypertonic Saline ◽

Normal Saline ◽

Severity Score ◽

Saline Group ◽

Clinical Severity ◽

Clinical Severity Score ◽

Group I ◽

Group Ii

Background: Bronchiolitis is one of the most common respiratory diseases requiring hospitalization. Nebulized epinephrine and salbutamol therapy has been used in different centres with varying results. Objective: The objective of the study was to compare the efficacy of nebulised adrenaline diluted with 3% hypertonic saline with nebulised adrenaline diluted with normal saline in bronchiolitis. Methods: Fifty three infants and young children with bronchiolitis, age ranging from 2 months to 2 years, presenting in the emergency department of Manikganj Sadar Hospital were enrolled in the study. After initial evaluation, patients were randomized to receive either nebulized adrenaline I .5 ml ( 1.5 mg) diluted with 2 ml of3% hypertonic saline (group I) ornebulised adrenaline 1.5 ml (1.5 mg) diluted with 2 ml of normal saline (group II). Patients were evaluated again 30 minutes after nebulization. Results: Twenty eight patients in the group I (hypertonic saline) and twenty five in groupII (normal saline) were included in the study. After nebulization, mean respiratory rate decreased from 63.7 to 48.1 (p<.01), mean clinical severity score decreased from 8.5 to 3.5 (p<.01) and mean oxygen satw·ation increased 94.7% to 96.9% (p<.01) in group I. In group II, mean respiratory rate decreased from 62.4 to 47.4 (p<.01), mean clinical severity score decreased from 7.2 to 4.1 (p<.01) and mean oxygen saturation increased from 94. 7% to 96. 7% (p<.01). Mean respiratory rate decreased by 16 in group I versus 14.8 (p>.05) in group 11, mean clinical severity score decreased by 4.6 in group versus 3 (p<.05) in group, and mean oxygen saturation increased by 2.2% and 1.9% in group and group respectively. Difference in reduction in clinical severity score was statistically significant , though the changes in respiratory rate and oxygen saturation were not statistically significant. Conclusion: The study concluded that both nebulised adrenaline diluted with 3% hypertonic saline and nebulised adrenaline with normal saline are effective in improving respiratory rate, clinical severity score and oxygen saturation in infants with bronchiolitis; and nebulised adrenaline with hypertonic saline is more effective than nebulised adrenaline with normal saline in improving clinical severity score in bronchiolitis.

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Comparative evaluation of nebulised 3% saline versus nebulised 0.9% saline in the treatment of acute bronchiolitis

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20192008 ◽

2019 ◽

Vol 6 (3) ◽

pp. 1182

Author(s):

Pragalatha Kumar A. ◽

Indhuja Rajarathinam ◽

Aruna Gowdra

Keyword(s):

Hospital Stay ◽

Severity Score ◽

Length Of Hospital Stay ◽

Signs And Symptoms ◽

Clinical Severity ◽

Controlled Study ◽

Acute Bronchiolitis ◽

Clinical Severity Score ◽

Group A ◽

Group B

Background: Acute bronchiolitis is the most common respiratory tract infection in young children. Despite the high prevalence of acute bronchiolitis, no consensus exists on the management. Studies have shown that except oxygen therapy, no other treatment found to be effective. Hence, the present study was conducted to find out the efficacy of nebulised 3% saline versus is 0.9% saline for the treatment of acute bronchiolitis.Methods: A prospective randomized controlled study of 150 children between the age group of 2 months to 24 months with signs and symptoms of Acute Bronchiolitis admitted to Indira Gandhi Institute of Child Health, Bangalore from January 2016 to December 2016 formed the study group, they were randomized into 2 groups, one received 3% saline nebulization and the other received 0.9% saline.Results: A total of 150 children were enrolled in the study, 75 children (group A) received 0.9% saline and 75 children (group B) received 3% saline. At 24 hours, the mean clinical severity score for group A was 2.49±1.03 and group B was 2.16±0.49 (P=0.013). The duration of hospital stay was shorter (1-3 days) in 3% saline with a mean of 2.35 days and was longer (3-5 days) in 0.9% saline with mean value of 4.04 days which was statistically significant (p <0.001).Conclusions: 3% saline nebulization can be used as an effective treatment for acute bronchiolitis. It significantly reduced the clinical severity score and length of hospital stay compared to 0.9% normal saline.

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Efficacy of prednisolone for children with acute bronchiolitis having family history of atopy: A randomized placebo-controlled trial

Northern International Medical College Journal ◽

10.3329/nimcj.v6i1.23151 ◽

2015 ◽

Vol 6 (1) ◽

pp. 9-11

Author(s):

Md Abid Hossain Mollah ◽

Khondokar Jahirul Hasan ◽

M Ekhlasur Rahman ◽

Shegufta Rahman

Keyword(s):

Placebo Group ◽

Family History ◽

Hospital Stay ◽

Oxygen Therapy ◽

Controlled Trial ◽

Length Of Hospital Stay ◽

Oral Prednisolone ◽

Acute Bronchiolitis ◽

Medical College ◽

History Of

Objective : To determine the efficacy of oral prednisolone among children with acute bronchiolitis who have associated family history of atopy.Materials and Methods : This randomized double blind placebo controlled trial was carried out in Dhaka Medical College Hospital during July08 to June10. A total of sixty patients (1-24 months) of acute bronchiolitis who had family history of atopy (e.g. allergic rhinitis, allergic conjunctivitis, asthma, eczema) were enrolled. After enrollment, allocation of either prednisolone or placebo to the study subjects were done randomly by lottery method and the researcher remained blind about the allocation. Finally 30 cases received prednisoloneorally at a dose of 2mg/kg/day 8 hourly for 3 consecutive days and 30 cases received placebo (made of flour). In addition, both the groups got same supportive measures. During intervention, study subjects were monitored by Modified Respiratory Distress Assessment Instrument (MRDAI) score twice daily for consecutive 3 days. Duration of oxygen therapy as well as length of hospital stay was also determined. Data were analyzed using appropriate statistical tests and a p value of <0.05 was considered significant.Results : The respiratory rate, accessory muscle use and auscultatory finding scores were significantly declined in Prednisolone group than the placebo group (p<.05). However, cyanosis score though declined in both groups, the difference was not significant (p>.05). Mean duration of oxygen therapy needed in Prednisolone group was significantly lesser than the placebo group (13.7 vs 24.1 hours; P<.01). Similarly, the length of hospital stay was shorter in prednisolone group than in placebo group (3.3 vs 4.6days; p<.01).Conclusions : Three days of oral prednisolone therapy along with supportive measures was found to be significantly useful among children with acute bronchiolitis having family history of atopy in terms of clinical recovery, oxygen requirement and duration of hospital stayNorthern International Medical College Journal Vol.6(1) 2014: 9-11

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Lung Ultrasound and Clinical Progression of Acute Bronchiolitis: A Prospective Observational Single-Center Study

Medicina ◽

10.3390/medicina56060314 ◽

2020 ◽

Vol 56 (6) ◽

pp. 314

Author(s):

Antonio Di Mauro ◽

Anna Rita Cappiello ◽

Angela Ammirabile ◽

Nicla Abbondanza ◽

Francesco Paolo Bianchi ◽

...

Keyword(s):

Hospital Stay ◽

Oxygen Therapy ◽

Lung Ultrasound ◽

Length Of Hospital Stay ◽

Supplemental Oxygen ◽

Acute Bronchiolitis ◽

Clinical Progression ◽

Single Center Study ◽

Ultrasound Score ◽

Center Study

Background and Objectives: Recent literature suggests that lung ultrasound might have a role in the diagnosis and management of bronchiolitis. The aim of the study is to evaluate the relationship between an ultrasound score and the clinical progression of bronchiolitis: need for supplemental oxygen, duration of oxygen therapy and hospital stay. Materials and Methods: This was a prospective observational single-center study, conducted in a pediatric unit during the 2017–2018 epidemic periods. All consecutive patients admitted with clinical signs of acute bronchiolitis, but without the need for supplemental oxygen, underwent a lung ultrasound in the first 24 h of hospital care. The lung involvement was graded based on the ultrasound score. During clinical progression, need for supplemental oxygen, duration of oxygen therapy and duration of hospital stay were recorded. Results: The final analysis included 83 patients, with a mean age of 4.5 ± 4.1 months. The lung ultrasound score in patients that required supplemental oxygen during hospitalization was 4.5 ± 1.7 (range: 2.0–8.0), different from the one of the not supplemented infants (2.5 ± 1.8; range: 0.0–6.0; p < 0.001). Ultrasound score was associated with the need for supplemental oxygen (OR = 2.2; 95% CI = 1.5–3.3; p < 0.0001). Duration of oxygen therapy was not associated with LUS score (p > 0.05). Length of hospital stay (coef. = 0.5; 95% CI = 0.2–0.7; p < 0.0001) correlates with LUS score. Conclusion: Lung ultrasound score correlates with the need of supplemental oxygen and length of hospital stay in infants with acute bronchiolitis.

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Exploring the Efficacy of Using Hypertonic Saline for Nebulizing Treatment in Children with Bronchiolitis: a Meta-Analysis of Randomized Controlled Trials

10.21203/rs.3.rs-27194/v1 ◽

2020 ◽

Author(s):

Chia-Wen Hsieh ◽

Hui-Chuan Su ◽

Kee-Hsin Chen ◽

Chiehfeng Chen

Keyword(s):

Respiratory Distress ◽

Hospital Stay ◽

Randomized Controlled Trials ◽

Hypertonic Saline ◽

Saline Solution ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Controlled Trials ◽

Acute Bronchiolitis ◽

Randomized Controlled

Abstract Introduction: Acute bronchiolitis is the most common lower respiratory infection in children. It is particularly prone to dyspnea among children under two years old. Inhaled hypertonic saline (HS) has recently been shown to be a favorable therapy, because of its facility to draw fluid from the submucosa and adventitial spaces, decreasing airway edema. The aim of this systematic review and meta-analysis was to evaluate the efficacy and safety of HS in the implementation of vapor treatment among children with bronchiolitis.Methods: A 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.Results: In total, 4186 children from 32 publications were included. Compared to the control group, the HS group exhibited significantly reducing the level of severity of respiratory distress, included studies used the Clinical Severity Score (95% CI −1.15, −0.27, I² = 73%) and Respiratory Distress Assessment Instrument (95% CI −0.95, −0.26, I²= 0%) for evaluation respectively. Further, the HS group decreased the length of hospital stay 0.54 days (95% CI −0.86, −0.32, I²= 81%). Conclusion: We conclude that nebulized 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 rigor randomize controlled trails with large sample size are needed.

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A comparative study of inhalational therapy versus supportive management in children aged 2 months to 2 years suffering from acute bronchiolitis

International Journal of Contemporary Pediatrics ◽

10.18203/2349-3291.ijcp20180456 ◽

2018 ◽

Vol 5 (2) ◽

pp. 383

Author(s):

Shaik Nazeer Ahmed ◽

Suman Poosala

Keyword(s):

Hospital Stay ◽

Hypertonic Saline ◽

Length Of Hospital Stay ◽

P Value ◽

Acute Bronchiolitis ◽

Cross Sectional ◽

Discharge Data ◽

Nebulized Salbutamol ◽

Group B ◽

Supportive Management

Background: The study was conducted with the aim to compare the effectiveness of nebulized hypertonic (3%) saline and nebulized salbutamol over supportive management to assess and monitor the clinical response in the above three modalities of management, to compare the length of stay in the hospital and to identify the risk factors for severe disease.Methods: This descriptive, cross-sectional hospital-based study was conducted at RICH Pediatric Hospital, Pogathota, Nellore, Andhra Pradesh from January 2015 to October 2016. A total of 120 children were included in the study. They were randomized into three treatment groups consisting of 40 in each. Group A received only supportive management, Group B received nebulization with 4 ml of 3% hypertonic saline along with supportive management and Group C received nebulization with 2.5 ml (2.5 mg) of salbutamol along with supportive management. Nebulization were given at intervals of 4 hours, six times a day until the patient was ready for discharge. Data was entered in Microsoft excel and analysis was done using SPSS version. A p-value of <0.05 was considered to be statistically significant.Results: Out of 120 children involved in the study, majority 56 (46.66%) children were <6 months age. Male preponderance was observed in the study (M:F-1.4:1). Higher proportion of moderate to severe cases was from rural area (61 cases). More severe cases were seen in lower socioeconomic class people and who had history of second hand smoking (21.67%). Clinically better improvement was seen in children that received nebulized hypertonic saline along with supportive management with mean length of hospital stay of 2.5 days when compared to only supportive management with mean length of hospital stay of 3.25 days. The mean length of hospital stays with nebulized salbutamol along with supportive management is 3.05 days which is not clinically significant. Of the 120 children studied, 118 (98.33%) survived and were discharged, while 2 children who presented critically succumbed to death (1.67%).Conclusions: Therapy with nebulized 3% hypertonic saline reduced the length of hospital stay in children <2 years suffering from acute bronchiolitis. Due to the efficacy and cost-effectiveness of the treatment, nebulized hypertonic saline should be considered for clinical management of acute bronchiolitis in children <2 years.

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Exploring the efficacy of using hypertonic saline for nebulizing treatment in children with bronchiolitis: a meta-analysis of randomized controlled trials

BMC Pediatrics ◽

10.1186/s12887-020-02314-3 ◽

2020 ◽

Vol 20 (1) ◽

Author(s):

Chia-Wen Hsieh ◽

Chiehfeng Chen ◽

Hui-Chuan Su ◽

Kee-Hsin Chen

Keyword(s):

Respiratory Distress ◽

Hospital Stay ◽

Randomized Controlled Trials ◽

Hypertonic Saline ◽

Saline Solution ◽

Meta Analysis ◽

Length Of Hospital Stay ◽

Controlled Trials ◽

Acute Bronchiolitis ◽

Randomized Controlled

Abstract Background 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. 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. Methods A 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. Results There 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%). Conclusions We 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.

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