Volume 360:2079-2089 May 14, 2009 Number 20 Epinephrine and Dexamethasone in Children with Bronchiolitis
Amy C. Plint, M.D., M.Sc., David W. Johnson, M.D., Hema Patel, M.D., M.Sc., Natasha Wiebe, M.Math., Rhonda Correll, H.B.Sc.N., Rollin Brant, Ph.D., Craig Mitton, Ph.D., Serge Gouin, M.D., Maala Bhatt, M.D., M.Sc., Gary Joubert, M.D., Karen J.L. Black, M.D., M.Sc., Troy Turner, M.D., Sandra Whitehouse, M.D., Terry P. Klassen, M.D., M.Sc., for Pediatric Emergency Research Canada (PERC) ABSTRACT Background Although numerous studies have explored the benefitof using nebulized epinephrine or corticosteroids alone to treatinfants with bronchiolitis, the effectiveness of combining thesemedications is not well established. Source Information Methods We conducted a multicenter, double-blind, placebo-controlledtrial in which 800 infants (6 weeks to 12 months of age) withbronchiolitis who were seen in the pediatric emergency departmentwere randomly assigned to one of four study groups. One groupreceived two treatments of nebulized epinephrine (3 ml of epinephrinein a 1:1000 solution per treatment) and a total of six oraldoses of dexamethasone (1.0 mg per kilogram of body weight inthe emergency department and 0.6 mg per kilogram for an additional5 days) (the epinephrine–dexamethasone group), the secondgroup received nebulized epinephrine and oral placebo (the epinephrinegroup), the third received nebulized placebo and oral dexamethasone(the dexamethasone group), and the fourth received nebulizedplacebo and oral placebo (the placebo group). The primary outcomewas hospital admission within 7 days after the day of enrollment(the initial visit to the emergency department). Results Baseline clinical characteristics were similar amongthe four groups. By the seventh day, 34 infants (17.1%) in theepinephrine–dexamethasone group, 47 (23.7%) in the epinephrinegroup, 51 (25.6%) in the dexamethasone group, and 53 (26.4%)in the placebo group had been admitted to the hospital. In theunadjusted analysis, only the infants in the epinephrine–dexamethasonegroup were significantly less likely than those in the placebogroup to be admitted by day 7 (relative risk, 0.65; 95% confidenceinterval, 0.45 to 0.95, P=0.02). However, with adjustment formultiple comparisons, this result was rendered insignificant(P=0.07). There were no serious adverse events. Conclusions Among infants with bronchiolitis treated in theemergency department, combined therapy with dexamethasone andepinephrine may significantly reduce hospital admissions. (CurrentControlled Trials number, ISRCTN56745572 [controlled-trials.com] .) The authors' affiliations are listed in the Appendix. Address reprint requests to Dr. Plint at the Children's Hospital of Eastern Ontario, 401 Smyth Ave., Ottawa, ON K1H 8L1, Canada, or at [email protected] . http://content.nejm.org/cgi/content/abstract/360/20/2079
