Mandelberg 2003.

Methods	Design: randomised, double‐blind, parallel‐group, controlled trial
Participants	Setting: paediatric inpatient ward, Edith Wolfson Medical Center, Israel Eligible: not stated Randomised: 27 (3% saline group); 26 (0.9% saline group) Completed: 27 hypertonic saline group; 25 normal saline group Gender (male): 57.7% Age (mean ± SD): 2.9 ± 2.1 months (range 0.5 to 12 months) Inclusion criteria: infants with clinical presentation of viral bronchiolitis with temperature > 38 ºC that led to hospitalisation Exclusion criteria: cardiac disease, chronic respiratory disease, previous wheezing episode, age > 12 months, SaO₂ < 85% in room air, changes in consciousness and/or progressive respiratory failure requiring mechanical ventilation
Interventions	Intervention group: nebulised 3% saline solution (4 mL) plus 1.5 mg epinephrine Control group: nebulised 0.9% saline solution (4 mL) plus 1.5 mg epinephrine The treatment was given 3 times/day at intervals of 8 h, until the infant was ready for discharge. All inhaled treatments were delivered using a nebuliser (Aeromist Nebulizer Set 61400; B&F Medical by Allied; Toledo, OH) connected to a source of pressurised oxygen at a flow rate of 5 L/min.
Outcomes	Length of hospital stay Wang clinical severity score Oxygen saturation Pulse rate Radiograph assessment score Number of add‐on treatments Adverse events
Notes	RSV positive: 85% in hypertonic saline group; 88% in normal saline group
Risk of bias
Bias	Authors' judgement	Support for judgement
Random sequence generation (selection bias)	Unclear risk	No details provided.
Allocation concealment (selection bias)	Low risk	Study solutions were similar in colour, smell, and other physical properties. The code of the therapeutic package (hypertonic saline versus normal saline solution) was deposited with the statistician.
Blinding (performance bias and detection bias) All outcomes	Low risk	Double‐blind
Incomplete outcome data (attrition bias) All outcomes	Low risk	1 (1.8%) withdrawal after randomisation
Selective reporting (reporting bias)	Low risk	All predefined outcomes reported.
Other bias	Low risk	No other bias found.