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Dexamethasone in bronchiolitis: a randomised controlled trial
G Roosevelt1, K Sheehan, J Grupp-Phelan
1Department of Pediatrics, Northern Medical School, Chicago, Illinois, USA.
Insights
Dexamethasone did not improve symptom resolution or oxygen therapy duration in hospitalized infants with bronchiolitis. This study found no evidence to support corticosteroid use for this common childhood respiratory illness.
Area of Science:
- Pediatrics
- Respiratory Medicine
- Clinical Pharmacology
Background:
- Corticosteroids, including dexamethasone, are frequently used for infant bronchiolitis despite a lack of evidence for their efficacy.
- Bronchiolitis is a common respiratory infection in infants, often requiring hospitalization.
Purpose of the Study:
- To evaluate the effectiveness of dexamethasone in hospitalized infants diagnosed with bronchiolitis.
- To determine if dexamethasone impacts symptom resolution time and the need for oxygen therapy.
Main Methods:
- A randomized, double-blind, placebo-controlled trial was conducted involving infants under 12 months hospitalized for bronchiolitis.
- Participants received either intramuscular dexamethasone or a placebo for three doses.
- Key outcomes measured included time to symptom resolution and duration of oxygen therapy, assessed using clinical severity scores and pulse oximetry.
Main Results:
- No significant differences were observed between the dexamethasone and placebo groups in terms of symptom resolution time or duration of oxygen therapy.
- While more infants in the dexamethasone group initially had oxygen saturation below 95%, this did not translate to improved clinical outcomes.
- Demographics, illness duration, and viral status (RSV) did not alter the study's findings.
Conclusions:
- The study provides no support for the use of dexamethasone in treating infants hospitalized with bronchiolitis.
- Current clinical practice of prescribing corticosteroids for bronchiolitis may not be evidence-based.
Background:
Although corticosteroids are commonly prescribed in the treatment of bronchiolitis, there is no evidence on the efficacy of these drugs in this disorder. We designed a randomised, double-blind, prospective study to assess the efficacy of dexamethasone in infants with bronchiolitis who require hospital management.
Methods:
Infants younger than 12 months who had been admitted to hospital for an initial episode of wheezing, were randomly allocated intramuscular dexamethasone (1 mg/kg daily) or placebo, every 24 h for three doses. We excluded infants who were younger than 4 weeks, who required admission to the intensive care unit, or who had a history of congenital heart disease, mechanical ventilation, or supplemental oxygen use. We assessed infants on admission and every 12 h thereafter--vital signs were taken, severity of accessory muscle use and wheezing were measured by a clinical severity score, and pulse oximetry in room air was done. Our primary endpoints were the time to resolution of symptoms--defined as the number of assessments needed to reach oxygen saturation of more than 95% while receiving no supplemental oxygen, an accessory muscle score of 0, a wheeze score of 0 or 1, and resumption of normal feeding--and duration of oxygen therapy. Follow-up assessments were made 10-14 days after discharge by telephone. We used a proportional-hazards model for our survival analysis.
Findings:
197 infants presented with bronchiolitis that required inpatient management. 75 were not enrolled (31 no consent, 28 no approach made, 16 transferred elsewhere). Of the 122 enrolled, four were excluded (clinical deterioration, diagnosis of cystic fibrosis, previous intubation, did not receive all study treatment). There were no differences between the dexamethasone (n = 65) and placebo-treated infants in demographic factors, exposure to tobacco smoke, duration of illness, presence of respiratory syncytial virus (RSV) antigen, respiratory rate, or severity score. More dexamethasone-treated patients had an initial oxygen saturation of 95% or less (51 [79%] dexamethasone vs 31 [59%] placebo, p = 0.02). There were no differences in duration of oxygen therapy (p = 0.74) or time to resolution of symptoms (p = 0.22). Stratification for presence of RSV antigen or family history of atopy did not affect the results.
Interpretation:
Our findings do not support the use of dexamethasone in the treatment of bronchiolitis in infants.