Dexamethasone for Bronchiolitis—The Controversy Continues

Abstract

Infectious Diseases| October 01 2007 Dexamethasone for Bronchiolitis—The Controversy Continues AAP Grand Rounds (2007) 18 (4): 38–39. https://doi.org/10.1542/gr.18-4-38 Views Icon Views Article contents Figures & tables Video Audio Supplementary Data Peer Review Share Icon Share Twitter LinkedIn Tools Icon Tools Get Permissions Cite Icon Cite Search Site Citation Dexamethasone for Bronchiolitis—The Controversy Continues. AAP Grand Rounds October 2007; 18 (4): 38–39. https://doi.org/10.1542/gr.18-4-38 Download citation file: Ris (Zotero) Reference Manager EasyBib Bookends Mendeley Papers EndNote RefWorks BibTex toolbar search nav search search input Search input auto suggest search filter All PublicationsAll JournalsAAP Grand RoundsPediatricsHospital PediatricsPediatrics In ReviewNeoReviewsAAP NewsAll AAP Sites Search Advanced Search Topics: bronchiolitis, dexamethasone Source: Corneli HM, Zorc JJ, Mahajan P, et al. A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis. N Engl J Med. 2007; 357:331–339; doi:10.1056NEJMoa071255 The bronchiolitis study group of the Pediatric Emergency Care Applied Research Network (PECARN) evaluated the effectiveness of a single oral dose of dexamethasone for bronchiolitis in a double-blinded, randomized, controlled trial. The study was conducted in 20 pediatric emergency departments during the months of November through April 2004 to 2006. Only previously healthy infants with a first episode of bronchiolitis that was assessed as moderate or severe based on a Respiratory Distress Assessment Instrument (RDAI) score of >6 (range 0 to 17) were eligible. A total of 600 infants two to 12 months old were enrolled in the study; 305 were randomized to the dexamethasone group (dose: 1 mg/kg, maximum 12 mg) and 295 to the placebo group. Study children received other treatments, such as inhaled bronchodilators, at the discretion of the examining physician. Eight infants were excluded from further analysis: two were admitted prior to receiving study medication, five received the wrong medication, and one received an insufficient dose of the medication. Respiratory Assessment Change Score (RACS), respiratory and heart rates, temperature, and oxygen saturation in room air were recorded one and four hours after drug administration and the decision to admit or discharge was made at the four-hour time point. Parents of study patients were contacted by telephone seven to ten days after the visit to determine if subsequent hospitalization, unscheduled medical visits, or adverse events had occurred. The primary outcome was whether the patient was discharged or hospitalized at the four-hour time point; RACS was a secondary outcome. Similar analyses comparing the efficacy of dexamethasone and placebo in the sub-group of children with a history of eczema or family history of asthma, were also conducted Baseline demographic and clinical characteristics were similar in the two groups. Among the 269 infants tested for respiratory syncytial virus (RSV), no difference in rate of hospitalization was found between those who were RSV-positive or -negative. There were no significant differences between infants in the dexamethasone or placebo group for mean RACS value and hospitalization rate (39.7% vs 41%, P=.74). Among those hospitalized the lengths of stay for infants in the two treatment groups were also not significantly different. Sub-group analyses had similar results. There were few adverse events, with no differences between the two groups. The authors conclude that one dose of oral dexamethasone failed to alter the respiratory status and subsequent outcome of infants with bronchiolitis. Drs. Rathore and Barton have disclosed no financial relationship relevant to this commentary. This commentary does not contain a discussion of an unapproved/investigative use of a commercial product/device. The use of corticosteroids in infants with bronchiolitis has been controversial, with several small studies providing contradictory results.1,2 A recent publication from one institution in Thailand, reviewed in these pages, found that a single dose of dexamethasone (0.6 mg/kg) administered to hospitalized... You do not currently have access to this content.