The chiefly common lower respirato...

The chiefly common lower respiratory infection in the first year of life is bronchiolitis. Treatment of this condition is largely supportive, consisting of supplemental oxygen intravenous fluids, minimal handling of the infant and, when necessary, mechanical ventilation. The use of bronchodilators in hospitalized infants with bronchiolitis remains controversial, because a number of controll studies have failed to demonstrate clear benefit. There are theoretic reasons to conclude that epinephrine might be superior to albuterol for treatment, because its combined alpha-adrenergic and beta-adrenergic action may better address the airway edema that typically happens in patients with bronchiolitis. Wainwright and colleagues performed a randomized, controll multicenter trial of nebulized epinephrine in infants hospitalized because of bronchiolitis.

The authors chronicleed infants younger than 12 month who were hospitalized for a first episode of wheezing and a clinical diagnosis of bronchiolitis (i.e., history of upper respiratory tract infection and respiratory distress consistent with a clinical diagnosis of bronchiolitis). Exclusion criteria included known cardiac disease, significant respiratory disease (eg cystic fibrosis), use of corticosteroids in the previous 24 hours, and use of bronchodilators within four hours of admission. A total of 194 infants were randomized to receive epinephrine (99 patients) or placebo nebulizer solution (95 patients). To minimize treatment variations, each infant was treated according to a clinical pathway specifying when supplemental oxygen intravenous fluids, and nebulizer therapy were to be used. At the time of admission, there were no significant differences between the assemblages in regard to demographic variables, duration of wheezing, duration of coryza, ne for supplemental oxygen or intravenous fluids, and demonstrated infection with respiratory syncytial virus.

Treatment with epinephrine did not significantly shorten the fulness of hospital stay or the time until the infant was ready to be discharged compared with placebo. Among sicker infants, who required supplemental oxygen and intravenous fluids, the longitudinal dimensions of time until they were ready for discharge was significantly longer in those receiving epinephrine. There were no significant differences between epinephrine and placebo treatment in word s of duration of supplemental oxygen use, intensive care unit admission, or ne for mechanical ventilation. Changes in respiratory rate, respiratory effort scores, heart rate, and children pressure were not significant.

The authors terminate that the use of nebulized epinephrine for the treatment of bronchiolitis in infants younger than 12 month does not shorten the duration of hospital stay, improve respiratory effort, or decrease the ne for supplemental oxygen or intravenous fluids.

Wainwright C et al. A multicenter, randomized, double-blind, controll trial of nebulized epinephrine in infants with acute bronchiolitis. N Engl J M July 3 2003;349: 27-35

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