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Bronchiolitis is the leading cause of hospitalization of infants in the U.S. Use of steroids for infants with bronchiolitis remains controversial because of the lack of high-quality, sufficiently powered studies. In a multisite, double-blind clinical trial, researchers randomized 600 infants (age range, 2–12 months) who presented to the emergency department with no prior history of wheezing and a clinical picture consistent with moderate-to-severe bronchiolitis to receive either a single dose of oral dexamethasone (1 mg/kg) or placebo. The primary outcome was hospitalization 4 hours after drug administration.
The admission rate was virtually identical in the steroid and placebo groups (39.7% and 41.0%, respectively). No differences emerged in subgroup analyses of infants who were positive for respiratory syncytial virus, those younger than 6 months, or those with a history of eczema or a family history of asthma. Mean length of stay for hospitalized infants and subsequent admissions during the 7 days after the intervention were similar in the two groups.
Corneli HM et al. A multicenter, randomized, controlled trial of dexamethasone for bronchiolitis. N Engl J Med 2007 Jul 26; 357:331-9.
Comment
This study likely represents the definitive study on the use of steroids for infants with bronchiolitis in the ambulatory care setting — steroids convey no benefit. However, infants with a prior history of wheezing were excluded. I am sure some clinicians will continue to administer steroids to infants who are admitted with bronchiolitis despite the lack of compelling evidence. I do not believe that steroids have a role in the treatment of bronchiolitis.