A multicenter, randomized, double-blind, controlled trial of nebulized epinephrine in infants with acute bronchiolitis

Claire Wainwright*, Luis Altamirano, Marise Cheney, Joyce Cheney, Scott Barber, Darrell Price, Sue Moloney, Ann Kimberley, Nick Woolfield, Susan Cadzow, Frank Fiumara, Peter Wilson, Steve Mego, Dianne VandeVelde, Sharon Sanders, Peter O'Rourke, Paul Francis

*Corresponding author for this work

Research output: Contribution to journalArticleResearchpeer-review

204 Citations (Scopus)

Abstract

BACKGROUND: The treatment of infants with bronchiolitis is largely supportive. The role of bronchodilators is controversial. Most studies of the use of bronchodilators have enrolled small numbers of subjects and have examined only short-term outcomes, such as clinical scores. 

METHODS: We conducted a randomized, double-blind, controlled trial comparing nebulized singleisomer epinephrine with placebo in 194 infants admitted to four hospitals in Queensland, Australia, with a clinical diagnosis of bronchiolitis. Three 4-ml doses of 1 percent nebulized epinephrine or three 4-ml doses of normal saline were administered at fourhour intervals after hospital admission. Observations were made at admission and just before, 30 minutes after, and 60 minutes after each dose. The primary outcome measures were the length of the hospital stay and the time until the infant was ready for discharge. The secondary outcome measures were the degree of change in the respiratory rate, the heart rate, and the respiratory-effort score and the time that supplemental oxygen was required. 

RESULTS: There were no significant overall differences between the groups in the length of the hospital stay (P=0.16) or the time until the infant was ready for discharge (P=0.86). Among infants who required supplemental oxygen and intravenous fluids, the time until the infant was ready for discharge was significantly longer in the epinephrine group than in the placebo group (P=0.02). The need for supplemental oxygen at admission had the greatest influence on the score for severity of illness and strongly predicted the length of the hospital stay and the time until the infant was ready for discharge (P < 0.001). There were no significant changes in the respiratory rate, blood pressure, or respiratory-effort scores from before each treatment to after each treatment. The heart rate was significantly increased after each treatment with epinephrine (P=0.02 to P < 0.001). 

CONCLUSIONS: The use of nebulized epinephrine did not significantly reduce the length of the hospital stay or the time until the infant was ready for discharge among infants admitted to the hospital with bronchiolitis.

Original languageEnglish
Pages (from-to)27-35
Number of pages9
JournalNew England Journal of Medicine
Volume349
Issue number1
DOIs
Publication statusPublished - 3 Jul 2003
Externally publishedYes

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