Background: Respiratory Syncytial Virus (RSV) bronchiolitis is a leading cause of lower respiratory tract infection in infants,particularly in those under two months of age. While supportive care remains the mainstay of treatment, nebulized hypertonic saline (HS) has been explored for its potential to enhance airway clearance and improve clinical outcomes. Objective: To evaluate the efficacy of nebulized 3% hypertonic saline in reducing respiratory distress and improving recovery outcomes in infants under two months of age diagnosed with RSV-positive bronchiolitis. Methods: This randomized controlled trial included 45 infants aged ≤60 days diagnosed with RSV-positive bronchiolitis. All participants received nebulized 3% hypertonic saline every 8 hours for four consecutive days. Clinical outcomes were assessed using the Modified Respiratory Distress Assessment Instrument (MRDAI) scores, oxygen saturation (SpO₂), duration of oxygen therapy, and length of hospital stay. Descriptive statistics and repeated measures analysis were performed to evaluate treatment response over time. Results: The mean age of participants was 36.91 ± 1.76 days; 73.3% were male. Significant reductions in MRDAI scores were observed from baseline (6.56 ± 1.21) to Day 4 (1.29 ± 0.18), with a mean difference of 5.27 ± 0.97 (p<0.001). SpO₂ improved from 91.46 ± 1.58% at admission to 93.13 ± 0.16% after 24 hours. The average duration of oxygen therapy was 10.12 ± 1.61 hours. Rapid recovery within 72 hours occurred in 86.6% of cases. The mean hospital stay was 62.98 ± 2.29 hours. Conclusion: Nebulized 3% hypertonic saline is effective in improving respiratory distress, oxygenation, and recovery in RSV-positive bronchiolitis cases among infants ≤2 months.