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Previous Volume 349:27-35 July 3, 2003 Number 1 Next

	Full Text PDF PDA Full Text PowerPoint Slide Set Editorial by Wohl, M. E. B. Letters Add to Personal Archive Add to Citation Manager Notify a Friend E-mail When Cited E-mail When Letters Appear PubMed Citation

ABSTRACT

Background The treatment of infants with bronchiolitis is largely supportive. The role of bronchodilators is controversial. Most studies of the use of bronchodilators have enrolled small numbers of subjects and have examined only short-term outcomes, such as clinical scores.

Methods We conducted a randomized, double-blind, controlled trial comparing nebulized single-isomer epinephrine with placebo in 194 infants admitted to four hospitals in Queens-land, Australia, with a clinical diagnosis of bronchiolitis. Three 4-ml doses of 1 percent nebulized epinephrine or three 4-ml doses of normal saline were administered at four-hour intervals after hospital admission. Observations were made at admission and just before, 30 minutes after, and 60 minutes after each dose. The primary outcome measures were the length of the hospital stay and the time until the infant was ready for discharge. The secondary outcome measures were the degree of change in the respiratory rate, the heart rate, and the respiratory-effort score and the time that supplemental oxygen was required.

Results There were no significant overall differences between the groups in the length of the hospital stay (P=0.16) or the time until the infant was ready for discharge (P=0.86). Among infants who required supplemental oxygen and intravenous fluids, the time until the infant was ready for discharge was significantly longer in the epinephrine group than in the placebo group (P=0.02). The need for supplemental oxygen at admission had the greatest influence on the score for severity of illness and strongly predicted the length of the hospital stay and the time until the infant was ready for discharge (P<0.001). There were no significant changes in the respiratory rate, blood pressure, or respiratory-effort scores from before each treatment to after each treatment. The heart rate was significantly increased after each treatment with epinephrine (P=0.02 to P<0.001).

Conclusions The use of nebulized epinephrine did not significantly reduce the length of the hospital stay or the time until the infant was ready for discharge among infants admitted to the hospital with bronchiolitis.

Source Information

From the Department of Respiratory Medicine, Royal Children's Hospital, Brisbane (C.W., L.A., M.C., J.C., S.B., P.F.); Gold Coast Hospital, Gold Coast (D.P., S. Moloney, A.K.); Caboolture Hospital, Caboolture (N.W., S.C., P.W., S. Mego, D.V.); Redcliffe Hospital, Redcliffe (F.F.); and the School of Population Health, University of Queensland, Brisbane (S.S., P.O.) — all in Queensland, Australia.

Address reprint requests to Dr. Wainwright at the Department of Respiratory Medicine, Royal Children's Hospital, Herston Rd., Brisbane, Queensland 4029, Australia, or at claire_wainwright{at}health.qld.gov.au.

Full Text of this Article

Related Letters:

Treatment of Bronchiolitis
Zwerdling R. G., O'Sullivan B. P., Wainwright C., Francis P., Wohl M. E., Chernick V.
Extract | Full Text | PDF  
N Engl J Med 2003; 349:1384-1385, Oct 2, 2003. Correspondence

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