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Dexamethasone Treatment Not Beneficial in Children Mechanically Ventilated with Respiratory Syncytial Virus: Presented at ATS

By Bonnie Darves

SEATTLE, WA -- May 25, 2003 -- Use of the adrenocortical steroid dexamethasone to treat infants with respiratory syncytial virus (RSV) does not appear to improve their outcomes with respect to duration of ventilator and oxygen use, according to a new study.

Because RSV is a common cause of lower respiratory tract infections (LRTI) in children younger than 2 years, and the disease is immune-mediated, it has been thought that immune-modulating drugs might help children on ventilators recover more quickly and avoid certain long-term effects -- such as persistent wheezing -- of mechanical ventilation. An earlier study found oral prednisone to be somewhat effective in reducing ventilator duration and length of stay, while most other studies have not found corticosteroid use to be beneficial in such patients.

On May 19^th at the American Thoracic Society International Conference, Dutch researchers presented findings from a new study that support what most related research has found: that steroids provide limited benefits.

Their double-blind, placebo-controlled trial was designed to determine the efficacy of intravenous dexamethasone in infants who were mechanically ventilated for RSV-LRTI. Of the 82 patients, 37 received dexamethasone in four doses of 0.6 mg/kg over 48 hours, and 45 received placebo. Mean age in the dexamethasone group was 5.9 weeks compared with 9.8 weeks in the placebo cohort.

"The dexamethasone was not beneficial in these RSV-LRTI patients, but we did see some improvements for a subgroup of patients with bronchiolitis," said lead author J.B.M. van Woensel of Emma Children's Hospital in Amsterdam, Netherlands. He added that the "immune-mediated phenomena may be more dominant" in patients with bronchiolitis than in those with pneumonia, based on the fact that those 18 patients were on the ventilator 4.3 fewer days than the 19 with pneumonia and required less supplemental oxygen.

At end point, both the dexamethasone and placebo groups had been in the pediatric intensive care unit for 9 days and had received supplemental oxygen for 10 days. The dexamethasone group had slightly lower ventilator duration -- 6.9 days versus 8.5 in the placebo group -- but was otherwise comparable.


[Study title: Dexamethasone for Treatment of Patients Mechanically Ventilated for Lower Respiratory Tract Infection Caused by Respiratory Syncytial Virus. Abstract PG57]

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