Does Normal Saline Have Clinical Effects in Infants with Bronchiolitis?

The objective of this systematic review and meta-analysis was to measure the short-term association of nebulizednormal saline with physiologic measures of respiratory status in children having bronchiolitis by comparingnebulized normal saline with the use of other placebos. Randomized clinical trials comparing children 2 years oryounger with bronchiolitis who were treated with nebulized normal saline were included. Studies enrolling atreatment group receiving an alternative placebo were included for comparison of normal saline with otherplacebos. Pooled estimates of the association with respiratory scores, respiratory rates, and oxygen saturationwithin 60 minutes of treatment were generated for nebulized NS vs another placebo and for change before and afterreceiving nebulized normal saline. A total of 29 studies including 1583 patients were included. Standardized meandifferences 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 differencein respiratory score (25 studies) after nebulized NS was –0.7 (95% CI, –0.7 to –0.6; I2 = 62%). The weighted meandifference 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 oxygensaturation (23 studies) after nebulized NS was –0.4% (95% CI, –0.6%to –0.2%; I2 = 79%). The authors concludedthat nebulized normal saline may be an active treatment for acute viral bronchiolitis and recommended that furtherevaluation should occur to establish whether it is a true placebo.