Bibliographic information
GuidelineWHO consolidated guidelines for the management of common childhood illness: management of asthma in children and adolescents and bronchiolitis in infants and young children
Year of Publication2026
Issuing InstitutionWorld Health Organization
Recommendation
New
In infants and children aged less than 2 years presenting or hospitalized with bronchiolitis, a trial of nebulized hypertonic saline (3%) is suggested rather than no nebulization.
Recommended in favor
Conditional
Certainty of evidence
Low
Notes and Remarks
- The majority of studies used a comparison with normal saline which may underestimate the effect of hypertonic saline.
- A trial of nebulized hypertonic saline in an individual patient may aid in clearance of secretions, but might not always be effective.
- Health facilities experience overcrowding during peak RSV season, making any reduction in the length of hospital stays through the use of nebulized hypertonic saline especially valuable.
- Health care workers should be aware that hypertonic saline can induce bronchoconstriction and may often require co-administration with bronchodilators.
- Caregivers need to be educated and counselled on the value of nebulization.
- When recommending the use of hypertonic saline nebulization on a large scale, especially during bronchiolitis epidemics, availability and stocks need to be addressed.
- The rules for discharge from hospital vary by hospital and by country, and even by age of the admitted infant, meaning that hospital stays for a 3-month-old may be different from those of a 15-month-old.