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Three Part Question

"In [children with acute upper respiratory tract infections] are [saline nasal drops] effective at [reducing duration or severity of symptoms]?

Clinical Scenario

Mrs B. brings in her 8 month old son with a 3 day history of mild fever and nasal congestion. You diagnose an acute URTI and provide advise on supportive measures. Mum mentions that her neighbour was given saline drops by the GP for their child and asks if you can prescribe the same. You wonder if there is any evidence of saline drops helping babies with colds

Search Strategy

Medline search (1966-04/12) limited to 'English' and 'human' and 'all child 0-18'.

(infants OR children OR paediatric OR babies) AND (rhinitis OR urti OR upper respiratory tract infection OR rhinosinusitis OR sinusitis OR common cold) AND (saline OR sodium chloride) AND (drops OR intranasal OR douching OR nasal OR nose drops OR spray OR topical OR irrigation)

Search Outcome

126 references, of which 1 is a cochrane review, 3 articles were not mentioned in the cochrane review but after critical appraisal were not directly relevant or of sufficient quality to include. All other relevant papers were considered in the cochrane review. Review of google scholar and references from the appraised papers revealed no further material that hadn't been included in the Cochrane review

Comment(s)

There were only 3 RCT's that were of sufficient quality to include in the Cochrane review for saline nasal irrigation in URTI. Of these RCT's 2 looked at children and 1 at adults. No papers looking specifically at use of saline nose drops in infants with acute URTI were found. No other high quality relevant papers were found that were not included in the Cochrane review. There is limited evidence that saline nasal irrigation is effective for symptoms of acute upper respiratory infections. One of the RCT's showed a trend toward reduced antibiotic use and a reduction in time off work/school with nasal saline drops compared to control in children with URTI. Minor adverse events including nosebleeds were reported and 40-44% of babies were shown to have difficulty with or intolerance of nasal drops.

Clinical Bottom Line

Saline nasal drops are a safe treatment that may be mildly beneficial to some infants with acute URTI however there is insufficient evidence currently to recommend it is a standard treatment.