University of Michigan
Department of Pediatrics
Evidence-Based Pediatrics Web Site

Question

• Among children hospitalized for respiratory syncytial virus (RSV) bronchiolitis, do steroids shorten the duration of hospitalization?

Clinical Bottom Lines

1. Corticosteroids are NOT effective in shortening the hospital stay for otherwise healthy children admitted with RSV bronchiolitis.^1,2,3
2. More research is needed regarding children with severe bronchiolitis requiring intubation.¹

Summary of Key Evidence

1. In a study from the Netherlands involving 39 patients, including some with a history of chronic lung disease, difference in length of stay in non-ventilated patients receiving prednisolone vs placebo was 1day (95% CI for difference -4.1 to 2.2, p=0.54).¹
2. A second study involving 32 previously healthy patients with their first episode of RSV bronchiolitis also showed no difference in length of stay. The mean duration of hospitalization was 6.6 days (SEM 0.3) in the placebo group and 6.0 days (SEM 0.7) in the group receiving dexamethasone.²
3. One small study involving 14 intubated patients with RSV did show a significant decrease in length of stay for patients receiving oral prednisolone vs. placebo(95% CI for difference -10.2 to -1.8, p<0.01).¹

Additional Comments

• None of the above cited articles performed a power analysis, thus they may contain type 2 errors.
• More research regarding the use of steroids in patients with severe bronchiolitis requiring intubation is needed.¹
• Both of the above cited studies were performed in northern European countries. Perhaps findings would be different with patients from other ethnic backgrounds.
• More research is needed regarding the long-term effect of steroid use. One study found that prednisolone during the acute phase of RSV bronchiolitis does not prevent wheezing or the development of asthma at the mean age of 5 years. However, this study was small, including only 47 patients, and relied on parental self reporting.⁴
• No clinically significant adverse side effects were noted in any of the studies mentioned; however, the sample sizes were small.

Citation

1. van Woensel JB, Wolfs TF, van Aalderen WM, Brand PL, Kimpen JL. Randomised double blind placebo controlled trial of prednisolone in children admitted to hospital with respiratory syncytial virus bronchiolitis. Thorax. 52(7):634-7, 1997.
2. De Boeck K, Van der Aa N, Van Lierde S, Corbeel L, Eeckels R. Respiratory syncytial virus bronchiolitis: a double-blind dexamethasone efficacy study. Journal of Pediatrics. 131(6):919-21, 1997.
3. Klassen TP, Sutcliffe T, Watters LK, Wells GA, Allen UD, Li MM. Dexamethasone in salbutamol-treated inpatients with acute bronchiolitis: a randomized, controlled trial. Journal of Pediatrics. 130(2):191-6, 1997.
4. van Woensel JB, Kimpen JL, Sprikkelman AB, Ouwehand A, van Aalderen WM. Long-term effects of prednisolone in the acute phase of bronchiolitis caused by respiratory syncytial virus. Pediatric Pulmonology. 30(2):92-6, 2000.
5. Springer C, Bar-Yishay E, Uwayyed K, Avital A, Vilozni D, Godfrey S. Corticosteroids do not affect the clinical or physiological status of infants with bronchiolitis. Pediatric Pulmonology. 9(3):181-5, 1990.
6. Connolly JH, Field CM, Glasgow JF, Slattery CM, MacLynn DM. A double blind trial of prednisolone in epidemic bronchiolitis due to respiratory syncytial virus. Acta Paediatrica Scandinavica. 58(2):116-20, 1969.

CAT Author: Priscilla Woodhams, MD

CAT Appraisers: <Reviewers>, MD

Date appraised: April 16, 2001