Intravenous magnesium sulphate in children with acute wheeze: a nationwide survey
Marlon van Weelden1, Bart E van Ewijk1, Frans B Plötz1,2
1Department of Pediatrics, Tergooi Hospital, Blaricum, The Netherlands.
Insights
Intravenous magnesium sulfate (iv MgSO4) is widely used for pediatric asthma and viral wheeze in the Netherlands, despite guidelines suggesting it only as a consideration. This practice is common even with limited evidence and reported side effects.
Area of Science:
- Pediatric Pulmonology
- Clinical Pharmacology
Background:
- Dutch guidelines suggest considering intravenous magnesium sulfate (iv MgSO4) for severe pediatric asthma and viral wheeze cases unresponsive to initial treatment.
- The actual clinical application of iv MgSO4 in these pediatric populations remains unclear.
Purpose of the Study:
- To assess the current utilization of iv MgSO4 in Dutch pediatric practice for exacerbations of acute episodic viral wheeze (AEVW) and acute asthma (AA).
Main Methods:
- A cross-sectional nationwide survey was conducted.
- Questionnaires were distributed to pediatricians and pediatric residents across academic and community teaching hospitals.
Main Results:
- 76% of 111 respondents regularly use iv MgSO4 for AEVW, and 96% for AA.
- Most users (89% for AEVW, 93% for AA) found it effective, though 23% and 17% reported adverse effects (hypotension).
- Lack of evidence and limited studies were primary reasons for not using MgSO4.
Conclusions:
- Intravenous magnesium sulfate is frequently used in Dutch pediatric practice for both AEVW and AA.
- This widespread use contrasts with national guidelines, which recommend it only as a treatment option to consider.
Objective:
Dutch guidelines recommend to consider intravenous magnesium sulfate (iv MgSO4) as a treatment option in case of failure of first line treatment in both children with exacerbations of acute episodic viral wheeze (AEVW) and acute asthma (AA). The implications on the actual use of iv MgSO4 iv in daily practice in both groups are unknown. Therefore, we conducted a cross-sectional nationwide survey to evaluate the use of iv MgSO4 in children with AEVW and AA.
Methods:
A questionnaire was handed out to pediatricians and pediatric residents in one academic and six community teaching hospitals.
Results:
In 111 respondents, 76% reported regular use of iv MgSO4 in children with AEVW and 96% in children with AA. In total 89% and 93% of users were convinced iv MgSO4 was effective in children with AEVW and AA, respectively. Adverse effects, mainly hypotension, were identified by 23% and 17% of users in AEVW and AA, respectively. Most common reasons not to give MgSO4 were lack of evidence and small amount of studies.
Conclusions:
IV MgSO4 is reported to be widely used in Dutch practice in both young children with AEVW and older children with AA by respondents, while the national guidelines advise only to consider this treatment option.
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