Don’t use systemic corticosteroids in children under 2 years of age with an uncomplicated lower respiratory tract infection.
Published guidelines recommend that corticosteroid medications not be used routinely in the management of bronchiolitis. Furthermore, additional studies in patients with other viral lower respiratory tract infections have failed to demonstrate any benefits.
These items are provided solely for informational purposes and are not intended as a substitute for consultation with a medical professional. Patients with any specific questions about the items on this list or their individual situation should consult their physician.
A Delphi panel of pediatric hospital medicine physicians with wide geographic representation was convened by the Society of Hospital Medicine (SHM). The panel developed an initial list of 20 items with input from colleagues at each of the panelists’ home institutions, which was then discussed and reduced to 11 items via consensus of the panel. A comprehensive literature review was undertaken for these 11 items, while they were concurrently circulated on the electronic listservs of SHM’s Pediatric Committee and the American Academy of Pediatrics’ Section on Hospital Medicine. The collated comments along with the results of the evidence review were then presented to the members of the panel.
Two rounds of Delphi voting took place via electronic submission of votes by the panel. Validity and feasibility of each item was assessed by the Delphi panel on a nine-point scale for each of the 11 items and the mean of each item was obtained. The aggregate score of the means of validity and feasibility decided the final five items. These recommendations were then submitted to the SHM Board for review and approval.
SHM’s disclosure and conflict of interest policy can be found at www.hospitalmedicine.org.
American Academy of Pediatrics. Diagnosis and Management of Bronchiolitis, Subcommittee on Diagnosis and Management of Bronchiolitis. Pediatrics. 2006 Oct;118(4):1774-93.
Klassen TP, Sutcliffe T, Watters LK, Wells GA, Allen UD, Li MM. Dexamethasone in salbutamol-treated inpatients with acute bronchiolitis: A randomized, controlled trial. J Pediatr. 1997 Feb;130(2):191-6.
Patel H, Platt R, Lozano JM, Wang EE. Glucocorticoids for acute viral bronchiolitis in infants and young children. Cochrane Database Syst Rev. 2004;(3):CD004878.
De Boeck K, Van der Aa N, Van Lierde S, Corbeel L, Eeckels R. Respiratory syncytial virus bronchiolitis: a double-blind dexamethasone efficacy study. J Pediatr. 1997 Dec;131(6):919-21.
Von Woensel JB, van Aalderen WM, Kimpen JL. Viral lower respiratory tract infection in infants and young children. BMJ 2003 Jul 5;327(7405):36–40.
Panickar J, Lakhanpaul M, Lambert PC, Kenia P, Stephenson T, Smyth A, Grigg J. Oral prednisolone for preschool children with acute virus-induced wheezing. N Engl J Med. 2009 Jan 22;360(4):329-38.