Paediatric nasal irrigation: The "fencing" method

Effect of Nasal Irrigation in Children With Omicron Variant of COVID-19 Infection

Objective: To explore the effect of nasal irrigation on the disappearance of symptoms and nucleic acid conversion in children with Omicron variant. Methods: This quasi-experimental study included children diagnosed with asymptomatic, mild, and moderate Omicron variant infection during the isolation observation period in the Shandong Public Health Clinical Center between April 1, 2022 and May 1, 2022. The children were divided into a routine group (received Lianhua Qingwen (LhQw) Granules), isotonic saline group (received LhQw Granules combined with isotonic saline nasal irrigation), and hypertonic saline group (received LhQw Granules combined with 3% hypertonic saline nasal irrigation), respectively. The primary outcomes were the time of symptom disappearance and nucleic acid conversion time. The secondary outcomes were peripheral white blood cell count (WBC), lymphocyte count (LYM), neutrophil count (NEU), and C-reactive protein (CRP) levels. Results: A total of 60 children (7.26 ± 3.15 years old) were included (20 per group). The average time of nucleic acid conversion in the 2 saline nasal irrigation groups was significantly reduced compared with the routine group (all P < 0.001), while the fever time and cough duration among the 3 groups were comparable (all P > 0.05). LYM count in the 2 saline nasal irrigation groups was significantly increased after treatment compared to before treatment and was significantly higher than in the routine group (all P < 0.05). There was no significant difference in LYM count between the isotonic and hypertonic saline groups (P = 0.76). Additionally, all children in the saline group well tolerated the treatment, and no adverse events occurred in the isotonic saline group. Conclusions: Timely use of saline nasal irrigation may promote nucleic acid conversion in children with Omicron virus infection.

Nasal Irrigation Improves the Nasal Related Quality of Life in Patients Undergoing Transsphenoidal Resection of Pituitary Adenoma

Background: After transsphenoidal pituitary adenoma resection patients have reduced olfactory function and quality of life. This study aimed to evaluate the effects of nasal irrigation on the nasal related quality of life in patients undergoing transsphenoidal pituitary adenoma resection. Methods: Patients undergoing transsphenoidal resection of pituitary adenomas in a tertiary hospital in China were included. The patients were randomly divided into a control group and nasal irrigation group according to the random sequence generated by the SPSS22.0 software. The 22-item sino-nasal outcome test (SNOT-22) was used to evaluate nasal related quality of life; lower SNOT-22 scores indicate a higher quality of life. The Toyota and Takagi (T&T) olfactometer test was used to evaluate the olfactory function of patients. Results: A total of 82 patients were finally included. The SNOT-22 scores of both groups after surgery were significantly higher than those before surgery (p < .05). The total SNOT-22 score of nasal irrigation group at one month (23.45 ± 3.72 vs. 27.48 ± 4.07) and three months (15.83 ± 2.86 vs. 21.82 ± 3.36) after surgery was lower than that in the control group (p < .05). There was no significant difference in olfactory function between the two groups at one month and three months after surgery (p > .05). The nasal mucosal score in the nasal irrigation group was significantly improved compared with the control group at one month and three months after surgery (p < .05). Conclusion: Nasal irrigation is associated with improved quality of life in patients undergoing transsphenoidal pituitary adenoma resection compared with the control group.

Consensus on Nasal Irrigation in Infants: A Delphi Study

INTRODUCTION

Nasal irrigation is regularly used in infants to relieve upper airway symptoms. However, because there is no consensus on good practice, nasal irrigation in infants is described and applied heterogeneously among clinicians and between clinical trials.

OBJECTIVE

The aim of this study was to establish consensus regarding the use of nasal irrigation in infants.

METHODS

A panel of Belgian physiotherapists and physicians experienced in performing nasal irrigation in infants were surveyed using the Delphi technique. Three survey rounds were used. Participants rated their level of (dis)agreement to each statement in each round using a 6-point Likert scale. Consensus was defined for statements which collected at least 75% of responses in agreement or disagreement. The questionnaire of Round 1 was built on nasal irrigation practice habits previously collected from parents, childcare workers, and healthcare professionals. Questionnaires from rounds 2 and 3 were amended based on experts written feedback.

RESULTS

Thirty experts (12 physicians and 18 physiotherapists) completed all 3 questionnaires. Consensus was achieved for 47 of 75 statements (63%) distributed over the following domains: "contraindications," "indications and frequency of use," "irrigation means," "solution preparation," "solution volume," "realization of the technique," and "assessment of the efficacy of nasal irrigation."

CONCLUSION

This study provides the first well-constructed consensus on good practice on nasal irrigation in infants. Consensus on several statements across different domains were established but require validation in future trials. This study also proposes direction for future research focusing on statements that did not reach consensus.

Nasal irrigation practice habits in infants: A Belgian survey: Nasal irrigation practice habits in infants

BACKGROUND

Nasal irrigation is widely used in infants to relieve nasal obstruction. However, the nasal irrigation technique has not been standardized, and nasal irrigation practice habits (NIPH) in infants have not been investigated. Our objective was to provide an overview of NIPH in infants among parents, childcare workers, and healthcare professionals living in Belgium.

METHODS

Parents, childcare workers, physiotherapists, nurses, pharmacists, and physicians were invited to fill in an electronic survey questioning their NIPH in infants. The survey was disseminated through social networks, practitioners' associations, and creches.

RESULTS

The questionnaire was fully completed by 359 participants. A ready-made solution was used by 93% of participants, of whom 92% used physiological saline. The prophylactic use of nasal irrigation was considered appropriate or very appropriate by 65% of all participants. The irrigation frequency was particularly heterogeneous among participants. The optimal solution propulsion speed and solution volume to be used depended on the group of participants being interviewed. At least 37% of parents and 20% of physicians did not take a stand on the optimal irrigation volume to use in each age category. On average, 83% of participants described performing nasal irrigation by lying the infant on one side and delivering the solution through the top nostril. Finally, 74% of respondents declared that no risk was associated with this technique.

CONCLUSION

Although some common NIPH viewpoints among the surveyed participants were identified, several disagreements were reported, reflecting the absence of a standardized method of nasal irrigation.

Prevalence of SARS-CoV-2 RNA on inanimate surfaces: a systematic review and meta-analysis

Coronavirus disease (COVID-19) is a respiratory disease affecting many people and able to be transmitted through direct and perhaps indirect contact. Direct contact transmission, mediated by aerosols or droplets, is widely demonstrated, whereas indirect transmission is only supported by collateral evidence such as virus persistence on inanimate surfaces and data from other similar viruses. The present systematic review aims to estimate SARS-CoV-2 prevalence on inanimate surfaces, identifying risk levels according to surface characteristics. Data were obtained from studies in published papers collected from two databases (PubMed and Embase) with the last search on 1 September 2020. Included studies had to be papers in English, had to deal with coronavirus and had to consider inanimate surfaces in real settings. Studies were coded according to our assessment of the risk that the investigated surfaces could be contaminated by SARS-CoV-2. A meta-analysis and a metaregression were carried out to quantify virus RNA prevalence and to identify important factors driving differences among studies. Thirty-nine out of forty retrieved paper reported studies carried out in healthcare settings on the prevalence of virus RNA, five studies carry out also analyses through cell culture and six tested the viability of isolated viruses. Overall prevalences of SARS-CoV-2 RNA on high-, medium- and low-risk surfaces were 0.22 (CI₉₅ [0.152-0.296]), 0.04 (CI₉₅ [0.007-0.090]), and 0.00 (CI₉₅ [0.00-0.019]), respectively. The duration surfaces were exposed to virus sources (patients) was the main factor explaining differences in prevalence.