Dexamethasone does not reduce length of hospitalization or recurrent wheezing 1 year after early bronchiolitis.
OBJECTIVE
It has been suggested that a 6-day dexamethasone course combined with adrenaline may significantly reduce the admission rate in outpatients. It has also been suggested that prednisolone may reduce recurrent wheezing. Our aim was to investigate whether treatment with steroids, especially high dose dexamethasone, is associated with the length of hospitalization or with recurrent wheezing.


METHODS
A prospective-retrospective observational study was performed from January 2009 to December 2011 in a secondary care hospital. Eighty previously healthy patients aged 7-180 days who were hospitalized with a first episode of acute bronchiolitis (AB) were studied. AB treatment was at the attending physician's discretion, among those tested for AB with some benefit. Eligible drugs included bronchodilators and steroids. Primary short-term outcome studied was days of hospitalization. Primary long term outcome was "recurrent wheezing".


RESULTS
Median length of hospitalization was 6 days for all groups. Patients treated with dexamethasone (1 mg/kg/day for 1 day, plus 0.6 mg/kg/day for 5 days) had an average length of hospitalization of 6.8 ± 3.1 (range, 4-20) days, those on prednisolone (prednisolone 1-2 mg/kg/day for 5 days) 7.0 ± 2.6 (range, 4-12) days and those with no steroids 6.6 ± 3.3 (3-21) days (no significant differences). The analysis showed no evidence of association of any management schedule with recurrent wheezing. After adjusting long-term outcome variables for potential confounders, comparisons remained no different.


CONCLUSIONS
High dose dexamethasone or medium-dose prednisolone during AB provided no benefit in a short or long-term period in young, previously healthy hospitalized infants.
Pediatrics Department University Hospital Infanta Sofía San Sebastián de los Reyes, Madrid, Spain - alfredo.tagarro@salud.madrid.org.
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Tagarro
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D001988:Bronchiolitis / Q000175:diagnosis / Q000188:drug therapy*; D001993:Bronchodilator Agents / Q000627:therapeutic use*; D003907:Dexamethasone / Q000627:therapeutic use*; D018450:Disease Progression; D004359:Drug Therapy, Combination; D005260:Female; D005938:Glucocorticoids / Q000627:therapeutic use*; D006801:Humans; D007223:Infant; D007231:Infant, Newborn; D007297:Inpatients; D007902:Length of Stay; D008297:Male; D011239:Prednisolone / Q000627:therapeutic use*; D011446:Prospective Studies; D012008:Recurrence; D012135:Respiratory Sounds / Q000187:drug effects; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D017211:Treatment Failure; D016896:Treatment Outcome
D001993:Bronchodilator Agents; D005938:Glucocorticoids; D003907:Dexamethasone; D011239:Prednisolone