Publication:

A comparative study of nebulized 3% hypertonic saline and normal saline in the management of respiratory syncytial virus-positive acute bronchiolitis in young infants

Background Acute bronchiolitis due to respiratory syncytial virus (RSV) is a major cause of hospitalization in infants, yet optimal therapeutic strategies are still under evaluation. Hypertonic saline has gained interest for its potential mucolytic and anti-edematous benefits. This study aimed to evaluate the clinical efficacy of nebulized 3% hypertonic saline compared to 0.9% normal saline in managing RSV-positive acute bronchiolitis in infants up to two months old.

Methods A double-blind, randomized controlled trial was conducted at Dhaka Shishu (Children) hospital involving 90 infants aged≤60 days with confirmed RSV-positive bronchiolitis. Participants were randomly assigned to receive either nebulized 3% hypertonic saline or 0.9% normal saline, administered three times daily until discharge. Clinical efficacy was measured using the modified respiratory distress assessment instrument (MRDAI), duration of oxygen therapy, and length of hospital stay.

Results The hypertonic saline group showed significantly greater clinical improvement starting at 12 hours post-intervention (MRDAI: 5.20±0.19 vs. 5.98±0.23; p=0.005). These infants also required shorter oxygen therapy (10.12±1.61 vs. 11.54±1.46 hours; p=0.025) and had significantly reduced hospital stays (62.98±2.29 vs. 79.64±3.69 hours; p=0.0001).

Conclusions Nebulized 3% hypertonic saline is more effective than normal saline in improving clinical outcomes in RSV-positive bronchiolitis in infants under two months, significantly reducing disease severity, oxygen requirement, and hospitalization duration. Incorporation into treatment protocols is strongly recommended.