Nebulized hypertonic saline in infants hospitalized with moderately severe bronchiolitis due to RSV infection: A multicenter randomized controlled trial

Pediatr Pulmonol. 2018 Mar;53(3):358-365. doi: 10.1002/ppul.23945. Epub 2018 Jan 12.


Introduction: The efficacy of nebulized hypertonic saline (HS) therapy for shortening hospital length of stay (LOS) or improving bronchiolitic symptoms remains controversial. Most studies enrolled small numbers of subjects and did not consider the role of respiratory syncytial virus (RSV), the most common cause of acute bronchiolitis. Our aim was to evaluate the efficacy and safety of nebulized HS therapy for acute bronchiolitis due to RSV in moderately ill hospitalized infants.

Materials and methods: This was an open-label, multicenter, randomized controlled trial comparing a nebulized HS treatment group with a normal saline (NS) group. The subjects, 128 infants with bronchiolitis due to RSV, were admitted to five hospitals in Tokyo, Japan. Three-percent HS or NS was administered via bronchodilator four times daily post-admission. The primary outcome was LOS, defined as the time until the patients fulfilled the discharge criteria, namely, absence of fever, no need for supplemental oxygen, and adequate feeding. Survival analysis was conducted in accordance with the intention-to-treat principle.

Results: The baseline characteristics were similar between the two groups. There was no significant overall difference in LOS between the groups (4.81 ± 2.14 days in HS vs 4.61 ± 2.18 days in NS; P = 0.60). Survival analysis by log-rank test also showed no significance (P = 0.62). Multivariate adjustment did not significantly alter the results. The treatment was well-tolerated, with no adverse effects attributable to the use of HS.

Conclusions: Nebulized HS therapy did not significantly reduce LOS among infants with bronchiolitis due to RSV.

Keywords: acute bronchiolitis; hypertonic saline nebulization; respiratory syncytial virus.

Publication types

  • Multicenter Study
  • Randomized Controlled Trial

MeSH terms

  • Administration, Inhalation
  • Bronchiolitis / drug therapy*
  • Double-Blind Method
  • Female
  • Humans
  • Infant
  • Length of Stay
  • Male
  • Nebulizers and Vaporizers
  • Patient Discharge
  • Respiratory Syncytial Virus Infections / drug therapy*
  • Saline Solution, Hypertonic / administration & dosage*


  • Saline Solution, Hypertonic