Hypertonic Saline for the Treatment of Bronchiolitis in Infants and Young Children: A Critical Review of the Literature

Jeffrey Baron, Gladys El-Chaar
Journal of Pediatric Pharmacology and Therapeutics: JPPT: the Official Journal of PPAG 2016, 21 (1): 7-26
Bronchiolitis, an infection of the lower respiratory tract, is the leading cause of infant and child hospitalization in the United States. Therapeutic options for management of bronchiolitis are limited. Hypertonic saline inhalation therapy has been studied in numerous clinical trials with mixed results. In 2014, the American Academy of Pediatrics (AAP) published updated guidelines on the diagnosis and management of bronchiolitis, which include new recommendations on the use of hypertonic saline. We reviewed all published clinical trials mentioned in the 2014 AAP guidelines, as well as additional trials published since the guidelines, and critically evaluated each trial to determine efficacy, safety, and expectations of hypertonic saline inhalation therapy. A total of 2682 infants were studied over the course of 22 clinical trials. Nine trials were carried out in the outpatient/clinic/emergency department and 13 in the inpatient setting. We agree with the AAP guidelines regarding the recommendation to use nebulized hypertonic saline for infants hospitalized with bronchiolitis, with the expectation of reducing bronchiolitis scores and length of stay when it is expected to last more than 72 hours. However, we also believe there might be an advantage for hypertonic saline in reducing admission rates from the emergency department, based on close examination of the results of recent trials. This review also highlights important gaps in the available literature that need to be addressed in order to define the role of inhaled hypertonic saline therapy.

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Amira Oshi

We are using 3% and we have good results


Meshal Almotair

We use 3%


fahrul wakil

I think we can try with NS 3% first


Hamed Amr

Tareq qotob 3% HTS


Enrique Mendoza Lopez

I had using Na 3% sínce 3 years in my office and reduced the hospitalización o. Bronchiilitis


Tarek Kotb

which hypertonic saline we can use 3% or 6 %


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