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Background Bronchiolitis, the most common infection of the lower respiratory tract in infants, is a leading cause of hospitalization in childhood. Corticosteroids are commonly used to treat bronchiolitis, but evidence of their effectiveness is limited.
Methods We conducted a double-blind, randomized trial comparing a single dose of oral dexamethasone (1 mg per kilogram of body weight) with placebo in 600 children (age range, 2 to 12 months) with a first episode of wheezing diagnosed in the emergency department as moderate-to-severe bronchiolitis (defined by a Respiratory Distress Assessment Instrument score
Results Baseline characteristics were similar in the two groups. The admission rate was 39.7% for children assigned to dexamethasone, as compared with 41.0% for those assigned to placebo (absolute difference, –1.3%; 95% confidence interval [CI], –9.2 to 6.5). Both groups had respiratory improvement during observation; the mean 4-hour RACS was –5.3 for dexamethasone, as compared with –4.8 for placebo (absolute difference, –0.5; 95% CI, –1.3 to 0.3). Multivariate adjustment did not significantly alter the results, nor were differences detected in later outcomes.
Conclusions In infants with acute moderate-to-severe bronchiolitis who were treated in the emergency department, a single dose of 1 mg of oral dexamethasone per kilogram did not significantly alter the rate of hospital admission, the respiratory status after 4 hours of observation, or later outcomes. (ClinicalTrials.gov number, NCT00119002
[ClinicalTrials.gov]
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6). We enrolled patients at 20 emergency departments during the months of November through April over a 3-year period. The primary outcome was hospital admission after 4 hours of emergency department observation. The secondary outcome was the Respiratory Assessment Change Score (RACS). We also evaluated later outcomes: length of hospital stay, later medical visits or admissions, and adverse events.
Source Information
From the University of Utah (H.M.C.) and Central Data Management and Coordinating Center (R.H., J.M.D.), Salt Lake City; the Children's Hospital of Philadelphia, Philadelphia (J.J.Z., K.N.S.); Children's Hospital of Michigan, Detroit (P.M., B.M.); Cincinnati Children's Hospital Medical Center, Cincinnati (S.D.R., R.M.R.); Washington University, St. Louis (K.A.N.); Columbia University, New York (J.S.B.); Children's National Medical Center, Washington, DC (K.M.B.); Devos Children's Hospital, Grand Rapids, MI (M.N.D.); Women and Children's Hospital of Buffalo, Buffalo, NY (K.A.L.); University of Rochester Medical Center, Rochester, NY (L.B.C.); Bellevue Hospital Center, New York (J.W.T.); Hurley Medical Center, Flint, MI (D.A.B.); Children's Hospital, Boston (M.N.B.); University of Maryland, Baltimore (G.T.); Johns Hopkins Children's Center, Baltimore (M.A.G.); Howard County General Hospital, Columbia, MD (D.M.); and the University of California, Davis, Medical Center, Sacramento (N.K.).
Address reprint requests to Dr. Corneli at P.O. Box 581289, Salt Lake City, UT 84158-1289.
Related Letters:
Dexamethasone for Bronchiolitis
Shell M. S. L., Calabria C. W., Casoni G. L., Poletti V., Stafler P., Corneli H. M., Zorc J. J., Kuppermann N.
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N Engl J Med 2007;
357:1659-1660, Oct 18, 2007.
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