Dexamethasone steroid treatment shows no benefit for kids with bronchiolitis

DMC Children's Hospital of Michigan has found that a common steroid treatment often prescribed for kids with bronchiolitis has no impact on improving their symptoms or in reducing hospitalization.

The research study findings appear in tomorrow's 2007 New England Journal of Medicine.

Prashant Mahajan, M.D., M.P.H, M.B.A, DMC Children's Hospital vice chief of pediatric emergency medicine and associate professor of pediatrics and emergency medicine at Wayne State University School of Medicine was a lead co- investigator in this nation-wide study involving 600 infants aged two to 12 months. The research was conducted through the 21-site Pediatric Emergency Care Applied Research Network (PECARN), the first federally-funded multi- institutional network for research in pediatric emergency medicine. Funded by the Health Resources and Services Administration Emergency Medical Services for Children (EMSC) program, the study also received funding from HRSA's research program, as well as core funding from PECARN. The PECARN network is funded with cooperative agreements with HRSA, as part of the EMSC program.

During the three-year study, researchers randomly enrolled infants at 20 Emergency Departments between the months of November through April and conducted a trial comparing a single dose of oral dexamethasone (a steroid medication) to a placebo to determine impact on rates of hospitalization. All infants had moderate-to-severe bronchiolitis, an illness often associated with respiratory syncytial virus (RSV). Of the total 600 infants who took part in the study, 305 patients received dexamethasone and 295 received standard care. The hospital admission rate for both groups was identical at nearly 40 percent. Both groups improved during treatment, but the placebo group did as well as the group treated with active medication. DMC Children's Hospital of Michigan contributed 60 infants to the study, the most of any site in Michigan.

Bronchiolitis is the leading cause of hospitalization for infants in the United States and accounts for more than 100,000 admissions each year. Hospital charges associated with the disease exceed $700 million annually. According to Dr. Mahajan, prescribing dexamethasone is a common practice among emergency room physicians and pediatricians to treat acute bronchiolitis. "Corticosteroids are commonly used to treat bronchiolitis although evidence of their effectiveness is limited." The findings of this study resolve controversy from prior research and are expected to help guide treatment for the most common cause of infant hospitalization.

Given the results of this study, though there is really no best treatment for children, researchers now can concentrate on finding better treatment and better preventative strategies.

DMC Children's Hospital of Michigan treats 500-600 patients annually for bronchiolitis. Hospital length of stay, later medical visits or admissions, and adverse events were also evaluated in the study.

The study lead investigators note that glucocorticoid medications still play an important role in other respiratory illnesses of childhood, such as asthma and croup. They point out these medications are not the androgenic steroids sometimes abused by athletes, and that the side effects seen with long-term steroid use are not a risk in the short-course treatments used for croup and asthma attacks.

Founded 120 years ago, the Children's Hospital of Michigan is the first and only hospital in the state dedicated exclusively to the treatment of children. A leader internationally in neurology and neurosurgery, cardiology, oncology, and diagnostic services, it is ranked one of America's best hospitals for children. More Michigan pediatricians are trained at the Children's Hospital of Michigan than in any other facility. Children's Hospital of Michigan is one of nine hospitals operated by the Detroit Medical Center (DMC). The DMC is proud to be the Official Healthcare Services Provider of the Detroit Tigers, Detroit Red Wings, Detroit Pistons and Detroit Shock.