Dexamethasone For Bronchiolitis In Infants: A Meta-analysis Of Randomized Controlled Trials

Objective To determine whether dexamethasone are efficacious in treating bronchiolitis in infants.Method We searched electronic database including Cochrane Library(2010, issue8), EMbase.com (1974-2010.8), Free Medline(1966-2010.8), Chinese Biomedical Literature Database(1978-2010.8), Chinese Scientific Journal Full-text Database(1994-2010.8), Chinese Journal Full-text Database(1989-2010.8), et al. All the randomized,placebo-controlled trials (RCTs) about dexamethasone for bronchiolitis in infants will be included regardless of blinding. According to the assessment method provided by Cochrane handbook 5.0.2, two searchers extracted information of included literatures independently:â‘ the basic characteristic of included trails, baseline of two groups' patients;â‘¡intervention study, outcome variables, lost of follow up and how to deal with it;â‘¢methodological quality. Meta-analysis will be used by RevMan5.0.1. Primary outcome measures:length of stay in hospital; hospitalizations; clinical score(were analyzed for 4 hours,1 day and 3 days after initial treatment,respectively).Second outcome measures:emergency department revisit rates; readmission to hospital rates; Adverse eventsResults We included Eight randomised controlled trials. with 1149 patients, of whom 590 were allocated for dexamethasone therapy, and 559 for placebo met the specified criteria.The results of Meta ananlysis show that dexamethasone tended to be associated with slightly low length of stay in hospital, hospitalizations, emergency department revisit rates and readmission to hospital rates compared with placebo group, but there were no statistically significant differences between two groups. Furthermore, considering Standardized Mean Difference was used to pool the data of the length of stay in hospital because of the different clinical scales among these included studies, which could produce spurious results, so we made a sensitivity analysis that omitted the data of Teeratakulpisarn J et al. And the outcome of sensitivity analysis still showed dexamethasone treatment didn't reduce the length of stay in hospital campared with placebo group.In addition, the changes in the clinical score did differ between two groups,but these differences were small and also still no statistically significant differences was found. It seem mean dexamethasone therapy didn't provide significant symptomatic relief whatever 4 hours,24 hours or 3 days of treatment from initial treatment. Though three studies reoported the diarrhea, pneumonia, occult blood and vomit, no statistically significant differences were found between two groups and the route of dexamethasone of these three studies were PO and IM.Conclusion This meta-analysis show that limited current evidence is unable to show any benefit of dexamethasone use in infants with bronchiolitis. Widespread use is not recommended until the benefits and harms can be clarified further. A large, multi-centre trial will be required to definitively clarify the role of dexamethasone in infants with bronchiolitis.