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Published on: August 7, 2017
Systemic corticosteroids in infant bronchiolitis: A meta-analysis
M M Garrison1, D A Christakis, E Harvey
1Department of Epidemiology, University of Washington, Seattle, USA.
Insights
Systemic corticosteroids significantly improved clinical symptoms, length of stay (LOS), and duration of symptoms (DOS) in hospitalized infants with bronchiolitis. This treatment offers a statistically significant benefit for infant respiratory illness management.
Area of Science:
- Pediatrics
- Pulmonology
- Pharmacology
Background:
- Bronchiolitis is a common viral respiratory infection in infants.
- Treatment options for bronchiolitis are limited, with a focus on supportive care.
- The efficacy of corticosteroids in managing bronchiolitis remains a subject of investigation.
Purpose of the Study:
- To evaluate the effectiveness of systemic corticosteroids in treating hospitalized infants diagnosed with bronchiolitis.
- To determine if corticosteroid treatment impacts key clinical outcomes such as length of stay and symptom duration.
Main Methods:
- A systematic literature search was conducted across major medical databases (Medline, Embase, Cochrane).
- Randomized, placebo-controlled trials (RCTs) investigating systemic corticosteroids for infant bronchiolitis were selected.
- Data on length of stay, duration of symptoms, and clinical scores were independently extracted by two investigators.
Main Results:
- Pooled analysis indicated a statistically significant reduction in length of stay or duration of symptoms by 0.43 days with corticosteroid treatment.
- A significant improvement in clinical scores was observed, favoring the corticosteroid group (effect size -1.60).
- Secondary analyses, while showing similar trends, did not reach statistical significance.
Conclusions:
- Published evidence suggests systemic corticosteroids provide a statistically significant benefit in managing bronchiolitis.
- Corticosteroid therapy appears to improve clinical symptoms, shorten hospital stays, and reduce symptom duration in infants.
- These findings support the consideration of corticosteroids in the treatment of hospitalized infants with bronchiolitis.
Objective:
To determine whether corticosteroids are efficacious in treating bronchiolitis in hospitalized infants.
Methods:
Online bibliographic databases (Medline, Embase, and Cochrane Clinical Trials Registry) were searched for: 1) bronchiolitis or respiratory syncytial virus, and 2) corticosteroid or glucocorticoid or steroidal antiinflammatory agents or adrenal cortex hormones. Reference lists from all selected articles were also examined. Randomized, placebo-controlled trials of systemic corticosteroids in treatment of infants hospitalized with bronchiolitis were selected by 2 investigators. Of 12 relevant publications identified in the literature search, 6 met the selection criteria and had relevant data available. Investigators independently extracted data for 3 outcomes: length of stay (LOS), duration of symptoms (DOS), and clinical scores.
Results:
In the pooled analysis, infants who received corticosteroids had a mean LOS or DOS that was.43 days less than those who received the placebo treatment (95% confidence interval: -.81 to -.05 days). The effect size for mean clinical score was -1.60 (95% confidence interval: -1.92 to -1.28), favoring treatment. Secondary analyses of mean LOS or DOS were performed on 5 trials that had clearly identified methods of randomization, 5 trials that measured LOS, and 4 trials that clearly excluded infants with previous wheezing. The estimates of effect were similar to the primary analysis but were not statistically significant.
Conclusions:
Combined, published reports of the effect of systemic corticosteroids on the course of bronchiolitis suggest a statistically significant improvement in clinical symptoms, LOS, and DOS.
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