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Evidence summaries

Glucocorticoids for Acute Viral Bronchiolitis in Infants and Young Children

Systemic or inhaled glucocorticoids appear not to have clinically relevant effects on admissions or length of hospitalization when used alone in infants and young children under two years of age with bronchiolitis defined as a first episode of wheezing. Level of evidence: "B"

A Cochrane review [Abstract] 1 included 17 studies with a total of 2 596 children < 24 months with acute bronchiolitis (first episode with wheezing ). Glucocorticoids did not significantly reduce outpatient admissions by days 1 (RR 0.92, 95% CI 0.78 to 1.08; 10 studies, n= 1 762) and 7 (RR 0.86, 95% CI 0.7 to 1.06; 6 studies, n= 1 530) when compared to placebo. There was no benefit in length of stay for inpatients (MD -0.18 days, 95% CI -0.39 to 0.04; 8 studies, n= 633). Unadjusted results from a large factorial low risk of bias RCT (n=400) found combined high-dose systemic dexamethasone and inhaled epinephrine reduced admissions by day 7 (baseline risk of admission 26%; RR 0.65, 95% CI 0.44 to 0.95; NNT 11, 95% CI 7 to 76), with no differences in short-term adverse effects. No other comparisons showed relevant differences in primary outcomes.

Comment: The quality of evidence is downgraded by inconsistency (heterogeneity in interventions and outcomes).

    References

    • Fernandes RM, Bialy LM, Vandermeer B et al. Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database Syst Rev 2013;(6):CD004878. [PubMed].

Primary/Secondary Keywords