Effects of Different Nasal Irrigation Methods on Pain, Crying and Procedure Times in Nasal Congestion in Infants: A Randomized Controlled Trial.

INTRODUCTION: Nasal saline irrigation is a recommended approach to relieve nasal symptoms and maintain upper airway patency in children with upper respiratory tract infections. This study aimed to evaluate the effects of different nasal irrigation methods for relieving nasal obstruction on pain, crying, and procedure times, and physiologic parameters in infants with acute upper respiratory tract infection. METHODS: A total of 126 infants with acute upper respiratory tract infection were randomized into 4 groups: isotonic saline nasal irrigation (n = 31), hypertonic saline nasal irrigation (n = 31), isotonic saline nasal irrigation + nontraumatic nasopharyngeal aspiration (n = 32), and hypertonic saline nasal irrigation + nontraumatic nasopharyngeal aspiration (n = 32). Nasal irrigation was performed with 10 mL of isotonic saline in the isotonic saline nasal irrigation group and 10 mL of hypertonic saline in the hypertonic saline nasal irrigation group. Nontraumatic nasopharyngeal aspiration was performed after isotonic saline irrigation in the isotonic saline nasal irrigation + nontraumatic nasopharyngeal aspiration group and hypertonic saline irrigation in the hypertonic saline nasal irrigation + nontraumatic nasopharyngeal aspiration group. The pain scores, crying and procedure times, and physiologic parameters were recorded 1 minute before and during the procedure and additionally 5 minutes after the procedure for physiological parameters. RESULTS: The mean face, legs, activity, cry, and consolability scores of infants in the isotonic saline nasal irrigation and isotonic saline nasal irrigation + nontraumatic nasopharyngeal aspiration groups were lower than those in the hypertonic saline nasal irrigation and hypertonic saline nasal irrigation + nontraumatic nasopharyngeal aspiration groups (F = 32.165; P = .00; η2 = 0.442). The crying time of infants in the isotonic saline nasal irrigation group was lower than that in the hypertonic saline nasal irrigation and hypertonic saline nasal irrigation + nontraumatic nasopharyngeal aspiration groups. Moreover, the crying time of infants in the isotonic saline nasal irrigation + nontraumatic nasopharyngeal aspiration group was lower than that in the hypertonic saline nasal irrigation group (F = 5.178; P = .002; η2 = .113). The procedure time for infants in the isotonic saline nasal irrigation group was shorter than that in the other groups (F = 8.779; P = .00; η2= 0.178). DISCUSSION: Isotonic saline nasal irrigation and isotonic saline nasal irrigation + nontraumatic nasopharyngeal aspiration are effective in reducing pain, crying, and procedural times associated with nasal irrigation in infants with upper respiratory tract infection. Emergency nurses can use isotonic saline nasal irrigation alone or in combination with nontraumatic nasopharyngeal aspiration to relieve nasal obstruction in infants.