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 ]Epinephrine and Dexamethasone in Children with Bronch

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dr.alatwane
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تاريخ التسجيل : 17/09/2008

مُساهمةموضوع: ]Epinephrine and Dexamethasone in Children with Bronch   الخميس مايو 14, 2009 4:16 pm


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.


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] .)




NEJM


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dr.aljuraisy
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تاريخ التسجيل : 15/09/2008

مُساهمةموضوع: رد: ]Epinephrine and Dexamethasone in Children with Bronch   الخميس مايو 14, 2009 7:05 pm


Thanks Dear Dr. Alatwani for this useful nice sub.
best wishes

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]Epinephrine and Dexamethasone in Children with Bronch
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