Epinephrine and dexamethasone in children with bronchiolitis. Export

@article{citeulike:4526408, abstract = {BACKGROUND: Although numerous studies have explored the benefit of using nebulized epinephrine or corticosteroids alone to treat infants with bronchiolitis, the effectiveness of combining these medications is not well established. METHODS: We conducted a multicenter, double-blind, placebo-controlled trial in which 800 infants (6 weeks to 12 months of age) with bronchiolitis who were seen in the pediatric emergency department were randomly assigned to one of four study groups. One group received two treatments of nebulized epinephrine (3 ml of epinephrine in a 1:1000 solution per treatment) and a total of six oral doses of dexamethasone (1.0 mg per kilogram of body weight in the emergency department and 0.6 mg per kilogram for an additional 5 days) (the epinephrine-dexamethasone group), the second group received nebulized epinephrine and oral placebo (the epinephrine group), the third received nebulized placebo and oral dexamethasone (the dexamethasone group), and the fourth received nebulized placebo and oral placebo (the placebo group). The primary outcome was hospital admission within 7 days after the day of enrollment (the initial visit to the emergency department). RESULTS: Baseline clinical characteristics were similar among the four groups. By the seventh day, 34 infants (17.1\%) in the epinephrine-dexamethasone group, 47 (23.7\%) in the epinephrine group, 51 (25.6\%) in the dexamethasone group, and 53 (26.4\%) in the placebo group had been admitted to the hospital. In the unadjusted analysis, only the infants in the epinephrine-dexamethasone group were significantly less likely than those in the placebo group to be admitted by day 7 (relative risk, 0.65; 95\% confidence interval, 0.45 to 0.95, P=0.02). However, with adjustment for multiple comparisons, this result was rendered insignificant (P=0.07). There were no serious adverse events. CONCLUSIONS: Among infants with bronchiolitis treated in the emergency department, combined therapy with dexamethasone and epinephrine may significantly reduce hospital admissions. (Current Controlled Trials number, ISRCTN56745572.)}, author = {Plint, Amy C. and Johnson, David W. and Patel, Hema and Wiebe, Natasha and Correll, Rhonda and Brant, Rollin and Mitton, Craig and Gouin, Serge and Bhatt, Maala and Joubert, Gary and Black, Karen J. and Turner, Troy and Whitehouse, Sandra and Klassen, Terry P. and {Pediatric Emergency Research Canada (PERC)}}, citeulike-article-id = {4526408}, citeulike-linkout-0 = {http://dx.doi.org/10.1056/NEJMoa0900544}, citeulike-linkout-1 = {http://content.nejm.org/cgi/content/abstract/360/20/2079}, citeulike-linkout-2 = {http://view.ncbi.nlm.nih.gov/pubmed/19439742}, citeulike-linkout-3 = {http://www.hubmed.org/display.cgi?uids=19439742}, day = {14}, doi = {10.1056/NEJMoa0900544}, issn = {1533-4406}, journal = {The New England journal of medicine}, keywords = {peds}, month = {May}, number = {20}, pages = {2079--2089}, posted-at = {2009-05-16 15:14:23}, priority = {2}, title = {Epinephrine and dexamethasone in children with bronchiolitis.}, url = {http://dx.doi.org/10.1056/NEJMoa0900544}, volume = {360}, year = {2009} }

TY - JOUR ID - citeulike:4526408 L3 - citeulike-article-id:4526408 N2 - BACKGROUND: Although numerous studies have explored the benefit of using nebulized epinephrine or corticosteroids alone to treat infants with bronchiolitis, the effectiveness of combining these medications is not well established. METHODS: We conducted a multicenter, double-blind, placebo-controlled trial in which 800 infants (6 weeks to 12 months of age) with bronchiolitis who were seen in the pediatric emergency department were randomly assigned to one of four study groups. One group received two treatments of nebulized epinephrine (3 ml of epinephrine in a 1:1000 solution per treatment) and a total of six oral doses of dexamethasone (1.0 mg per kilogram of body weight in the emergency department and 0.6 mg per kilogram for an additional 5 days) (the epinephrine-dexamethasone group), the second group received nebulized epinephrine and oral placebo (the epinephrine group), the third received nebulized placebo and oral dexamethasone (the dexamethasone group), and the fourth received nebulized placebo and oral placebo (the placebo group). The primary outcome was hospital admission within 7 days after the day of enrollment (the initial visit to the emergency department). RESULTS: Baseline clinical characteristics were similar among the four groups. By the seventh day, 34 infants (17.1%) in the epinephrine-dexamethasone group, 47 (23.7%) in the epinephrine group, 51 (25.6%) in the dexamethasone group, and 53 (26.4%) in the placebo group had been admitted to the hospital. In the unadjusted analysis, only the infants in the epinephrine-dexamethasone group were significantly less likely than those in the placebo group to be admitted by day 7 (relative risk, 0.65; 95% confidence interval, 0.45 to 0.95, P=0.02). However, with adjustment for multiple comparisons, this result was rendered insignificant (P=0.07). There were no serious adverse events. CONCLUSIONS: Among infants with bronchiolitis treated in the emergency department, combined therapy with dexamethasone and epinephrine may significantly reduce hospital admissions. (Current Controlled Trials number, ISRCTN56745572.) IS - 20 JF - The New England journal of medicine SN - 1533-4406 EP - 2089 TI - Epinephrine and dexamethasone in children with bronchiolitis. VL - 360 SP - 2079 KW - peds AU - Plint, Amy AU - Johnson, David AU - Patel, Hema AU - Wiebe, Natasha AU - Correll, Rhonda AU - Brant, Rollin AU - Mitton, Craig AU - Gouin, Serge AU - Bhatt, Maala AU - Joubert, Gary AU - Black, Karen AU - Turner, Troy AU - Whitehouse, Sandra AU - Klassen, Terry PY - 2009/05/14/ UR - http://dx.doi.org/10.1056/NEJMoa0900544 ER -