title: A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis.
abstract: 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 > or =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.
  
  
  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].).
authors.affiliation: University of Utah, Salt Lake City, USA.
authors.forename: Howard M
authors.initials: HM
authors.lastname: Corneli
authors.forename: Joseph J
authors.initials: JJ
authors.lastname: Zorc
authors.forename: Prashant
authors.initials: P
authors.lastname: Mahajan
authors.forename: Prashant
authors.initials: P
authors.lastname: Majahan
authors.forename: Kathy N
authors.initials: KN
authors.lastname: Shaw
authors.forename: Richard
authors.initials: R
authors.lastname: Holubkov
authors.forename: Scott D
authors.initials: SD
authors.lastname: Reeves
authors.forename: Richard M
authors.initials: RM
authors.lastname: Ruddy
authors.forename: Baqir
authors.initials: B
authors.lastname: Malik
authors.forename: Kyle A
authors.initials: KA
authors.lastname: Nelson
authors.forename: Joan S
authors.initials: JS
authors.lastname: Bregstein
authors.forename: Kathleen M
authors.initials: KM
authors.lastname: Brown
authors.forename: Matthew N
authors.initials: MN
authors.lastname: Denenberg
authors.forename: Kathleen A
authors.initials: KA
authors.lastname: Lillis
authors.forename: Lynn Babcock
authors.initials: LB
authors.lastname: Cimpello
authors.forename: James W
authors.initials: JW
authors.lastname: Tsung
authors.forename: Dominic A
authors.initials: DA
authors.lastname: Borgialli
authors.forename: Marc N
authors.initials: MN
authors.lastname: Baskin
authors.forename: Getachew
authors.initials: G
authors.lastname: Teshome
authors.forename: Mitchell A
authors.initials: MA
authors.lastname: Goldstein
authors.forename: David
authors.initials: D
authors.lastname: Monroe
authors.forename: J Michael
authors.initials: JM
authors.lastname: Dean
authors.forename: Nathan
authors.initials: N
authors.lastname: Kuppermann
mesh_terms: D000284:Administration, Oral; D001988:Bronchiolitis / Q000188:drug therapy* / Q000503:physiopathology; D003907:Dexamethasone / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D004311:Double-Blind Method; D004636:Emergency Service, Hospital; D005260:Female; D005938:Glucocorticoids / Q000008:administration & dosage / Q000009:adverse effects / Q000627:therapeutic use*; D006760:Hospitalization / Q000706:statistics & numerical data; D006801:Humans; D007223:Infant; D008297:Male; D012119:Respiration; D012135:Respiratory Sounds / Q000187:drug effects; D017211:Treatment Failure
chemical_list: D005938:Glucocorticoids; D003907:Dexamethasone