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Page: << Prev | 1 | 2 | 3 | Next >> To answer the question of whether or not dexamethasone is helpful for bronchiolitis in the youngest patients, Kuppermann and his colleagues from the Pediatric Emergency Care Applied Research Network conducted a double-blind, randomized study that included 600 children between the ages of 2 and 12 months.
Half of the children were given a single dose of oral dexamethasone (1 milligram per kilogram of body weight), and half of the children received an oral placebo.
Forty percent of babies on dexamethasone had to be hospitalized, compared to 41 percent of those on the placebo. Both groups also saw similar improvements in breathing. And, there was no difference in later outcomes, the study found.
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"If a young infant between 2 and 12 months of age presents to the emergency department with first-time wheezing in the wintertime, I would argue that it would be safer not to give steroids than to give them," Kupperman said.
"Sometimes it's just as important to identify medications that aren't effective as it is to identify those that are. We don't want to subject anyone, particularly infants, to unnecessary risks," said Kuppermann.
However, Kuppermann acknowledged that in real-life practice, physicians may still use corticosteroids because there are no reliable alternatives to treat bronchiolitis, and because it can sometimes be difficult to tell in infants whether wheezing is caused by bronchiolitis or asthma.
"These are tiny babies, wheezing and huffing. Can the physician do nothing? The majority of babies do get treatment, despite the fact that these treatments don't appear to be of value," said Dr. Caroline Hall, an infectious-disease specialist at the University of Rochester School of Medicine and Dentistry in New York, and the author of an accompanying editorial in the journal.
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