Nebulizing with 3% Saline for Infants with Cough

Effectiveness in Different Clinical Scenarios

The American Academy of Pediatrics recommends that nebulizing with 3% hypertonic saline is not used for treating cough in infants unless the cough is specifically related to bronchiolitis with a hospital stay expected to exceed 3 days 1
3% hypertonic saline may improve symptoms of mild to moderate bronchiolitis after 24 hours of use and may reduce hospital length of stay, but only in settings where the average stay exceeds 3 days 1

The American College of Chest Physicians recommends that inhaled osmotic agents, including hypertonic saline, are not used for children with chronic cough after acute viral bronchiolitis 2
Instead, these children should be managed according to standard pediatric chronic cough guidelines, which may include antibiotics targeted to common respiratory bacteria if wet/productive cough is present 2

There is no evidence supporting the use of hypertonic saline for general cough in infants outside the context of bronchiolitis 3, 4
Normal saline may be tried to loosen tenacious secretions, but there is no supporting scientific evidence for this practice 3, 4

Monitoring of oxygen saturation is recommended as unpredictable arterial oxygen desaturation may occur when using hypertonic saline for bronchiolitis 3, 5
Pre-treatment with a bronchodilator is recommended to reduce the risk of bronchospasm when using hypertonic saline for bronchiolitis 3, 4

Hypertonic saline should not be used as a substitute for other appropriate treatments when specific causes of cough are identified 2
The benefits of hypertonic saline in bronchiolitis may not be generalizable to healthcare settings where the average length of stay is less than 3 days 1
Supportive care remains the mainstay of treatment for infants with cough due to bronchiolitis 1
For chronic cough after bronchiolitis, evaluation for cough pointers and consideration of a 2-week course of antibiotics for wet/productive cough may be appropriate 2
Asthma medications should not be used for post-bronchiolitis cough unless other evidence of asthma is present 2