On Wed, 4 Jun 1997, KEVIN ROMA wrote:
> Recently had a child who presented with classic croup symptomology
> score of 4-5 .Started child on mist and B agonist and added to the regimen
> nebulized Dexamethasone .1 mg/kg Child did extremely well.This
> treatment was mentioned in Clinical Practice of EMERGENCY MEDICINE
> (ANN HARWOOD _NUSS) Does any one know of a study using this treatment?My
> lit search was uneventful.Any practicioners with personal experince using
> this treatment?
Here's a couple of citations that might be of interest:
Milton S. Hershey Medical Center, Hershey, PA; United States of America.
Treatment of croup with nebulized dexamethasone.
Journal of Family Practice. Vol 43(1) (pp 19-20), 1996.
Johnson DW. Schuh S. Koren G. Jaffe DM.
Child Health Research Unit, 1820 Richmond Rd SW, Calgary, Alta. T3T 5C7;
Outpatient treatment of croup with nebulized dexamethasone.
Archives of Pediatrics & Adolescent Medicine. Vol 150(4) (pp 349-355),
Purpose: To determine if treating children who have acute, moderate croup
with nebulized dexamethasone sodium phosphate in the emergency department
results in clinical improvement by 4 hours and a decrease in the
hospitalization rate. Design: Randomized, double-blind, placebo-controlled
trial. Setting: Emergency department, children's hospital. Patients:
Fifty- five children with croup who were in moderate respiratory distress
after treatment with mist for 30 minutes who met inclusion and exclusion
criteria. Measurements: Croup score, respiratory rate, heart rate, and
oxygen saturation were assessed by one of us (D.W.J. or S.S.) before
treatment and 2 and 4 hours after treatment. A staff pediatrician or
senior pediatric resident, also 'blind' to treatment, decided on admission
to or discharge from the hospital. The differences between groups for
change in croup score and hospitalization rate after treatment were
analyzed. Results: Evaluation of the croup scores disclosed a significant
improvement in the dexamethasone- treated group compared with the placebo
group at 4 hours (P=.005, Mann- Whitney U). However, the hospitalization
rate was not statistically different at the end of treatment (33% vs 52%,
P=.28) or after 24 hours (48% vs 60%, P=.56, Yates corrected chi2). Our
study has 80% power to detect a two-thirds reduction in hospitalization
rate. Two patients with neutropenia treated with dexamethasone had a
clinical course consistent with bacterial tracheitis. Conclusions:
Treatment of moderate croup with nebulized dexamethasone results in
clinical improvement within 4 hours. We did not show a decrease in
hospitalization rates, although our sample size was only large enough to
detect a 67% reduction in the rate of hospitalization. Given the
infectious complications and the absence of evidence for a sustained
clinical effect, we do not recommend that patients with croup be treated
with nebulized dexamethasone.
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