Nasal Irrigation With Saline Solution for Pediatric Acute Upper Respiratory Infections: A Systematic Review

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Abstract
Acute upper respiratory tract infections (URTIs) are defined as infectious diseases confined anatomically to the upper respiratory tract, with a duration of up to 28 days. Treatment for URTIs in pediatrics typically involves antipyretics and decongestants and, at times, antibiotics, despite most infections being viral. Nasal irrigation with saline solution is frequently used as an adjunct treatment for URTI symptoms. Currently, there is no consensus on whether nasal irrigation with saline offers significant benefits in reducing the severity of URTI symptoms. This systematic review aims to assess the scientific evidence supporting nasal irrigation with saline as a recommendation to alleviate symptom severity in pediatric URTI cases. We conducted a systematic literature search in PubMed, Cochrane Library, Medline, and Scopus databases, covering the period from January 2010 to May 2024 in Portuguese, Spanish, and English. MeSH terms used were: (((pediatrics) OR (children) OR (infant) OR (adolescent) OR (child)) AND ((isotonic saline solution) OR (nasal douching) OR (nasal saline irrigation) OR (nasal lavage fluid)) AND ((respiratory disease) OR (upper respiratory tract infection))). Only randomized controlled trials were included, and we assessed the risk of bias using the Cochrane risk-of-bias tool (ROBIS 2.0). The Strength of Recommendation Taxonomy (SORT) was applied to determine the level of evidence and strength of recommendation. The initial search yielded 158 articles, of which only four met the criteria for inclusion in this systematic review. All studies evaluated whether saline nasal irrigation, with or without additional treatments, contributes to symptom improvement in pediatric URTIs. Notably, some studies reported symptom relief and even faster recovery times with its use. Based on our analysis, nasal irrigation with saline solution may reduce symptom severity in children with URTIs, with a level of evidence of 2 and a recommendation strength of B. Further research with more robust methodologies is needed to confirm these findings.

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