Is nebulization safe for children



Is hypertonic saline administration via a nebulizer effective and safe for treating young children with acute bronchiolitis compared to normal saline?


Acute bronchiolitis is the most common lower respiratory tract infection in children up to two years of age. Bronchiolitis occurs when small structures (called bronchioles) leading to the lungs become infected, causing inflammation, swelling, and production of mucus. This makes breathing difficult, especially in very young children who develop coughing and wheezing.

Because bronchiolitis is usually caused by a virus, drug treatment is usually not effective. Hypertonic saline (a sterile salt water solution) inhaled as a fine mist through a nebulizer could help relieve wheezing and breathing problems.

We compared nebulized hypertonic (≥ 3%) saline with nebulized normal (0.9%) saline in young children with acute bronchiolitis.

This is an updated version of a review that was published in 2008, 2010 and 2013.

Research date

11th August 2017

Study characteristics

We identified 26 new studies for this update, 9 of which are pending evaluation. Accordingly, 17 studies (N = 3105) were added. We included a total of 28 studies in 4195 young children with acute bronchiolitis.

Main results

Nebulized hypertonic saline solution could reduce hospitalization time for infants admitted with acute bronchiolitis by 10 hours compared to normal saline. We found that the “clinical severity scores” used by clinicians to assess patient health improved in outpatient or inpatient children when they received nebulized hypertonic saline instead of normal saline. In addition, nebulized hypertonic saline solution could reduce the risk of inpatient admission for children treated on an outpatient basis or in the emergency room by 14%. We found only minor and spontaneously regressive side effects from the use of nebulized hypertonic saline solution when administered together with a drug that widens the airway (bronchodilator).

The shortening of the inpatient stay was smaller than previously assumed. However, the average 10 hour reduction in length of inpatient stay in young children is significant because bronchiolitis is generally short-lived. Nebulized hypertonic saline solution appears to be safe and widely available at low cost.

Quality of the evidence

The quality of the evidence was low to moderate: there was inconsistency in results between studies and a risk of bias in some studies. Future larger studies are therefore needed to confirm the benefit of nebulized hypertonic saline solution in outpatient and inpatient children with bronchiolitis.