Efficacy of dexamethasone injection for acute bronchiolitis in hospitalized children: A randomized, double‐blind, placebo‐controlled trial

Abstract

Controversy over the efficacy of systemic corticosteroids for acute bronchiolitis initiated this study. We conducted a randomized, double-blind, placebo-controlled trial to examine the efficacy of single dexamethasone injection for the treatment of acute bronchiolitis in young hospitalized children. The study, performed at the pediatric wards of a University Hospital and its affiliated hospital in Thailand, included 174 previously healthy children under 2 years of age, hospitalized with acute bronchiolitis. Each child received either a single intramuscular injection of 0.6 mg/kg dexamethasone or a placebo in addition to regular management. The primary outcome was the time from study entry to resolution of respiratory distress, determined by a clinical score derived from the respiratory rate, occurrence of wheezing, chest retraction, and oxygen saturation. Survival analysis using the Kaplan-Meier method and a log-rank test were performed. A single-dose, dexamethasone injection versus placebo produced a significant: (1) decrease in the time needed for resolution of respiratory distress (hazard ratio 1.56; 95% CI, 1.14-2.13; P = 0.005), (2) decrease in the mean duration of symptoms of 11.8 hr (95% CI, 3.9-19.7; P = 0.004), (3) decrease in the mean duration of oxygen therapy of 14.9 hr (95% CI, 5.3-24.4; P = 0.003), and (4) decrease in the mean length of hospital stay of 13.4 hr (95%CI, 2.6-24.2; P = 0.02). In conclusion, a single injection of dexamethasone yielded a significant clinical benefit for the treatment of previously healthy, young children hospitalized with acute bronchiolitis.

Management of Bronchiolitis in the Emergency Department: Impact of Evidence-Based Guidelines?

“…4 Many commonly used therapies such as bronchodilators and corticosteroids have no proven efficacy in the treatment of bronchiolitis. [5][6][7][8][9][10][11][12][13][14][15][16][17] The We considered several additional covariates in our analysis. The NHAMCS collects age in days for patients under 1 year of age, and age in years only for those aged .1 year.…”

Acute bronchiolitis

“…13 14 The Cochrane review showed no evidence of benefit for systemic steroids. 15 One trial found that a single injection of dexamethasone may help in acute bronchiolitis, 16 Cyanosis or really severe respiratory distress (respiratory rate >70 breaths/min, nasal flaring and/or grunting, severe chest wall recession) Marked lethargy leading to poor feeding Respiratory distress preventing feeding (<50% of usual intake in past 24 hours) Apnoeic episodes Diagnostic uncertainty (toxic infant, temperature ≥40 degrees centigrade) …”

Approach to a Child with Lower Airway Obstruction and Bronchiolitis

“…One trial (n=174) showed that a single dose of intravenous dexamethasone (0.6 mg/kg) results in (statistically but not clinically significant) shorter duration of hospitalization and time for resolution of respiratory distress [15,16].…”