Systemic Corticosteroids in Infant Bronchiolitis: A Meta-analysis

Garrison, Michelle M.; Christakis, Dimitri A.; Harvey, Eric; Cummings, Peter; Davis, Robert L.

doi:10.1542/peds.105.4.e44

Cited by 165 publications

(78 citation statements)

References 33 publications

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“…27 The majority of trials and systematic reviews available at the time of our cohort and the AAP practice guideline did not suggest a benefit of corticosteroids. 28 We found a surprising number of children were treated with medications we had not anticipated. Many children received inhaled ipratropium bromide and inhaled corticosteroids in the ED and during their admission, and were discharged from the ED and inpatient wards with a prescription for oral bronchodilators.…”

Section: Discussionmentioning

confidence: 92%

Management of Bronchiolitis in Community Hospitals in Ontario: a Multicentre Cohort Study

Plint

Taljaard

McGahern³

et al. 2016

CJEM

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Objectives: Bronchiolitis is the leading cause of hospital admission for infants, but few studies have examined management of this condition in community hospital settings. We reviewed the management of children with bronchiolitis presenting to community hospitals in Ontario. Methods: We retrospectively reviewed a consecutive cohort of infants less than 12 months old with bronchiolitis who presented to 28 Ontario community hospitals over a two-year period. Bronchiolitis was defined as first episode of wheezing associated with signs of an upper respiratory tract infection during respiratory syncytial virus season. Results: Of 543 eligible children, 161 (29.7%, 95% Confidence Interval (CI) 22.3 to 37.0%) were admitted to hospital. Hospital admission rates varied widely (Interquartile Range 0%-40.3%). Bronchodilator use was widespread in the emergency department (ED) (79.7% of patients, 95% CI 75.0 to 84.5%) and on the inpatient wards (94.4% of patients, 95% CI 90.2 to 98.6%). Salbutamol was the most commonly used bronchodilator. At ED discharge 44.7% (95% CI 37.5 to 51.9%) of patients were prescribed a bronchodilator medication. Approximately one-third of ED patients (30.8%, 95% CI 22.7 to 38.8%), 50.3% (95% CI 37.7 to 63.0%) of inpatients, and 23.5% (95% CI 14.4 to 32.7) of patients discharged from the ED were treated with corticosteroids. The most common investigation obtained was a chest x-ray (60.2% of all children; 95% CI 51.9 to 68.5%). Conclusions: Infants with bronchiolitis receive medications and investigations for which there is little evidence of benefit. This suggests a need for knowledge translation strategies directed to community hospitals. RÉSUMÉObjectif: La bronchiolite est le principal motif d'hospitalisation des enfants en bas âge, mais peu d'études ont porté sur la prise en charge de la maladie, dans les hôpitaux communautaires. Les auteurs de l'étude ont donc examiné la prise en charge de la maladie chez les enfants traités dans les hôpitaux communautaires, en Ontario. Méthode: Les auteurs ont procédé à un examen rétrospectif d'une cohorte d'enfants consécutifs, âgés de moins de 12 mois, qui souffraient d'une bronchiolite et qui ont été traités dans 28 hôpitaux communautaires en Ontario, sur une période de 2 ans. La bronchiolite a été définie comme un premier épisode de respiration sifflante, associé à des signes d'une infection des voies respiratoires supérieures durant la période du virus respiratoire syncytial. Résultats: Sur 543 enfants admissibles à l'étude, 161 (29,7%; intervalle de confiance [IC] à 95% : 22,3 à 37,0%) ont été hospitalisés. Les taux d'admission à l'hôpital variaient énormément (intervalle interquartile : 0-40,3%). L'utilisation des bronchodilatateurs était courante au service des urgences (SU) (79,7% des patients; IC à 95% : 75,0 à 84,5%) ainsi qu'à l'étage (94,4% des patients; IC à 95% : 90,2 à 98,6%). Le salbutamol était le brochodilatateur le plus utilisé. Au moment du congé du SU, un brochodilatateur avait été prescrit à 44,7% (IC à 95% : 37,5 à 51,9%) des pa...

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Section: Discussionmentioning

confidence: 92%

Management of Bronchiolitis in Community Hospitals in Ontario: a Multicentre Cohort Study

Plint

Taljaard

McGahern³

et al. 2016

CJEM

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“…A systematic review of the effect of corticosteroids on nonintubated infants with bronchiolitis showed a 0.5-day decrease in duration of hospitalization (37). A recent trial conducted among children in an emergency department showed that a single high dose of dexamethasone could prevent hospital admission in bronchiolitis (38).…”

Section: Discussionmentioning

confidence: 99%

Efficacy of interventions for bronchiolitis in critically ill infants: A systematic review and meta-analysis*

Davison

Ventre²,

Luchetti³

et al. 2004

Pediatric Critical Care Medicine

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“…Infected infants typically exhibit symptoms of upper respiratory tract infection with or without wheezing, but in premature infants, infants with congenital heart disease, and even in some infants without obvious predisposing factors, infection can progress to severe bronchiolitis, pneumonitis, and respiratory failure. Medical treatments for high risk infants are limited to prophylactic and supportive interventions because currently available antiviral and anti-inflammatory therapeutic agents have little impact on the natural progression of disease [reviewed in [1][2][3]. Similarly, in cattle, bovine respiratory syncytial virus (bRSV) is primarily a clinical disease in calves that occurs in seasonal outbreaks.…”

Section: Introductionmentioning

confidence: 99%

Mucosal inoculation with an attenuated mouse pneumovirus strain protects against virulent challenge in wild type and interferon-gamma receptor deficient mice

Ellis

Martin

Waldner

et al. 2007

Vaccine

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Protective mechanisms underlying the responses to mucosal vaccination are not yet clearly defined. Using the natural mouse pneumovirus pathogen, pneumonia virus of mice (PVM), we explore responses of wild type and interferon-gamma (IFNγ) receptor gene-deleted mice to virulent challenge after mucosal vaccination with an attenuated virus strain. Serum neutralizing antibodies develop after intranasal inoculation with 30 pfu of attenuated, replication-competent PVM strain 15, which correlate with diminished gross and microscopic pulmonary pathology and protection from weight loss in response to subsequent challenge with the virulent parent PVM strain J3666. Virus replication in response to challenge was blunted in PVM strain 15 vaccinated mice, as was local production of secretory mediators IFNγ, TNF-α, MIP-1α, and MIP-2. Interestingly, responses of vaccinated IFNγ receptor gene-deleted mice were indistinguishable from those of the wild type, suggesting that IFNγ signaling may not be crucial for the generation of adaptive responses to pneumovirus infection in vivo. (150 words).

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Systemic Corticosteroids in Infant Bronchiolitis: A Meta-analysis

Abstract: 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.

Cited by 165 publications

References 33 publications

Management of Bronchiolitis in Community Hospitals in Ontario: a Multicentre Cohort Study

Management of Bronchiolitis in Community Hospitals in Ontario: a Multicentre Cohort Study

Efficacy of interventions for bronchiolitis in critically ill infants: A systematic review and meta-analysis*

Mucosal inoculation with an attenuated mouse pneumovirus strain protects against virulent challenge in wild type and interferon-gamma receptor deficient mice

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