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Cochrane Database of Systematic Reviews

Nebulised hypertonic saline solution for acute bronchiolitis in infants

Overview of attention for article published in Cochrane database of systematic reviews, December 2017
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About this Attention Score

  • In the top 5% of all research outputs scored by Altmetric
  • High Attention Score compared to outputs of the same age (98th percentile)
  • High Attention Score compared to outputs of the same age and source (94th percentile)

Mentioned by

1 blog
1 policy source
155 tweeters
10 Facebook pages
1 Wikipedia page
1 Google+ user


53 Dimensions

Readers on

427 Mendeley
Nebulised hypertonic saline solution for acute bronchiolitis in infants
Published in
Cochrane database of systematic reviews, December 2017
DOI 10.1002/14651858.cd006458.pub4
Pubmed ID

Linjie Zhang, Raúl A Mendoza-Sassi, Claire Wainwright, Terry P Klassen


Airway oedema (swelling) and mucus plugging are the principal pathological features in infants with acute viral bronchiolitis. Nebulised hypertonic saline solution (≥ 3%) may reduce these pathological changes and decrease airway obstruction. This is an update of a review first published in 2008, and previously updated in 2010 and 2013. To assess the effects of nebulised hypertonic (≥ 3%) saline solution in infants with acute bronchiolitis. We searched the Cochrane Central Register of Controlled Trials (CENTRAL), MEDLINE, MEDLINE Epub Ahead of Print, In-Process & Other Non-Indexed Citations, Ovid MEDLINE Daily, Embase, CINAHL, LILACS, and Web of Science on 11 August 2017. We also searched the World Health Organization International Clinical Trials Registry Platform (WHO ICTRP) and ClinicalTrials.gov on 8 April 2017. We included randomised controlled trials and quasi-randomised controlled trials using nebulised hypertonic saline alone or in conjunction with bronchodilators as an active intervention and nebulised 0.9% saline, or standard treatment as a comparator in children under 24 months with acute bronchiolitis. The primary outcome for inpatient trials was length of hospital stay, and the primary outcome for outpatients or emergency department trials was rate of hospitalisation. Two review authors independently performed study selection, data extraction, and assessment of risk of bias in included studies. We conducted random-effects model meta-analyses using Review Manager 5. We used mean difference (MD), risk ratio (RR), and their 95% confidence intervals (CI) as effect size metrics. We identified 26 new trials in this update, of which 9 await classification due to insufficient data for eligibility assessment, and 17 trials (N = 3105) met the inclusion criteria. We included a total of 28 trials involving 4195 infants with acute bronchiolitis, of whom 2222 infants received hypertonic saline.Hospitalised infants treated with nebulised hypertonic saline had a statistically significant shorter mean length of hospital stay compared to those treated with nebulised 0.9% saline (MD -0.41 days, 95% CI -0.75 to -0.07; P = 0.02, I² = 79%; 17 trials; 1867 infants) (GRADE quality of evidence: low). Infants who received hypertonic saline also had statistically significant lower post-inhalation clinical scores than infants who received 0.9% saline in the first three days of treatment (day 1: MD -0.77, 95% CI -1.18 to -0.36, P < 0.001; day 2: MD -1.28, 95% CI -1.91 to -0.65, P < 0.001; day 3: MD -1.43, 95% CI -1.82 to -1.04, P < 0.001) (GRADE quality of evidence: low).Nebulised hypertonic saline reduced the risk of hospitalisation by 14% compared with nebulised 0.9% saline among infants who were outpatients and those treated in the emergency department (RR 0.86, 95% CI 0.76 to 0.98; P = 0.02, I² = 7%; 8 trials; 1723 infants) (GRADE quality of evidence: moderate).Twenty-four trials presented safety data: 13 trials (1363 infants, 703 treated with hypertonic saline) did not report any adverse events, and 11 trials (2360 infants, 1265 treated with hypertonic saline) reported at least one adverse event, most of which were mild and resolved spontaneously. Nebulised hypertonic saline may modestly reduce length of stay among infants hospitalised with acute bronchiolitis and improve clinical severity score. Treatment with nebulised hypertonic saline may also reduce the risk of hospitalisation among outpatients and emergency department patients. However, we assessed the quality of the evidence as low to moderate.

Twitter Demographics

The data shown below were collected from the profiles of 155 tweeters who shared this research output. Click here to find out more about how the information was compiled.

Mendeley readers

The data shown below were compiled from readership statistics for 427 Mendeley readers of this research output. Click here to see the associated Mendeley record.

Geographical breakdown

Country Count As %
United States 3 <1%
United Kingdom 2 <1%
Italy 1 <1%
Indonesia 1 <1%
Colombia 1 <1%
Spain 1 <1%
Portugal 1 <1%
Unknown 417 98%

Demographic breakdown

Readers by professional status Count As %
Student > Master 60 14%
Student > Bachelor 57 13%
Other 52 12%
Researcher 49 11%
Student > Postgraduate 34 8%
Other 108 25%
Unknown 67 16%
Readers by discipline Count As %
Medicine and Dentistry 220 52%
Nursing and Health Professions 51 12%
Pharmacology, Toxicology and Pharmaceutical Science 16 4%
Agricultural and Biological Sciences 13 3%
Biochemistry, Genetics and Molecular Biology 11 3%
Other 35 8%
Unknown 81 19%

Attention Score in Context

This research output has an Altmetric Attention Score of 112. This is our high-level measure of the quality and quantity of online attention that it has received. This Attention Score, as well as the ranking and number of research outputs shown below, was calculated when the research output was last mentioned on 17 November 2020.
All research outputs
of 17,679,473 outputs
Outputs from Cochrane database of systematic reviews
of 11,730 outputs
Outputs of similar age
of 417,452 outputs
Outputs of similar age from Cochrane database of systematic reviews
of 226 outputs
Altmetric has tracked 17,679,473 research outputs across all sources so far. Compared to these this one has done particularly well and is in the 98th percentile: it's in the top 5% of all research outputs ever tracked by Altmetric.
So far Altmetric has tracked 11,730 research outputs from this source. They typically receive a lot more attention than average, with a mean Attention Score of 25.3. This one has done particularly well, scoring higher than 96% of its peers.
Older research outputs will score higher simply because they've had more time to accumulate mentions. To account for age we can compare this Altmetric Attention Score to the 417,452 tracked outputs that were published within six weeks on either side of this one in any source. This one has done particularly well, scoring higher than 98% of its contemporaries.
We're also able to compare this research output to 226 others from the same source and published within six weeks on either side of this one. This one has done particularly well, scoring higher than 94% of its contemporaries.