Canadian doctors find better
treatment for babies with respiratory infection and slash
hospitalization rates
Canadian pediatricians have found a better
way to help babies suffering from a lung infection called
bronchiolitis and were able to reduce the number admitted to
hospital by more than one-third.
A national study, led by Dr. Amy Plint at the
Children’s Hospital of Eastern Ontario (CHEO) and University of
Ottawa, Dr. Terry Klassen of the University of Alberta, Stollery
Children’s Hospital, Dr. David Johnson at the Alberta Children’s
Hospital and University of Calgary, and Dr. Hema Patel at
Montreal Children’s Hospital and McGill University showed that
combining two common drugs cut hospital admissions by 35 per
cent.
Results of the study, which involved 800
babies in emergency departments in eight pediatric hospitals
across Canada are being published Thursday May 14, 2009 in the
New England Journal of Medicine.
“Thirty five per cent is a substantial drop.
These findings are truly significant to the health-care system
and to families of young children around the world,” said Plint
who was the lead study investigator and author. Plint is a
pediatric emergency physician at CHEO and associate professor in
Pediatrics and Emergency Medicine at the University of Ottawa.
“Bronchiolitis is a very common illness with symptoms that are
distressing for infants and their parents and results in a high
rate of hospital admissions and high health care costs. The
children in the study who received the combined drug treatment
got better sooner, went home faster, and were less likely to
need hospital care.”
Bronchiolitis, an inflammation of tiny airways
in the lungs called bronchioles, usually affects children under
the age of two, and especially those aged three to six months.
Usually caused by viral infections, it makes the baby cough,
wheeze and have difficulty breathing. In Canada, an estimated 35
in 1,000 babies are hospitalized with the condition each year,
with rates nearly doubling in the last 10 to 15 years. Annual
hospitalization costs for bronchiolitis in the U.S. have been
estimated to be as high as $700 million. In 1993 the cost of
bronchiolitis in Canada was conservatively estimated at $23
million and admission rates have doubled since this time.
“This is exciting because bronchiolitis is a
distressing disease for young children and their parents, and a
tremendous burden for the health care-system in terms of
hospital admissions,” says Klassen, professor and in the
Department of Pediatrics in the Faculty of Medicine & Dentistry
at the University of Alberta. “To date, there have been no clear
treatment options other than giving babies oxygen if their
oxygen levels were low and fluids if they weren’t feeding.”
One of the drugs in the study, called
epinephrine, is a bronchodilator which relaxes the muscles and
opens the airways; the other, called dexamethasone, is a steroid
that reduces inflammation. These types of drugs have been tried
as treatments for bronchiolitis, but studies have not supported
their effectiveness when used separately.
However this is the first large study to use
the two drugs together and “we found that two drugs together
produced surprising results” says Plint.
“The fact that combined treatment allowed many
more infants to be safely treated in their own homes, versus
in-hospital, is a tremendous benefit. Hospitalization is a
significant disruption of regular life for young infants and
their families,” explains Dr. Hema Patel from the Montreal
Children’s Hospital, McGill University.
A randomized clinical trial at multiple sites
in Canada was conducted to determine which treatment would be
more effective. Infants aged six weeks to 12 months and
diagnosed with bronchiolitis were randomly assigned to one of
four study groups. One group was treated with both epinephrine
and dexamethasone; one with only epinephrine; one with only
dexamethasone, and one group received a placebo.
The study found that infants who had the
combined drug treatment returned to normal breathing and feeding
more quickly, and were discharged faster. A follow-up seven
days later showed 35 per cent fewer hospitalizations compared to
infants from the other groups.
The study was conducted by the collaborative
research group Pediatric Emergency Research Canada (PERC) and
funded by the Canadian Institutes of Health Research (CIHR), at
$1.96 million, with additional funding from the Alberta
Children’s Hospital Foundation. Eight hospitals across Canada
participated including: Children’s Hospital of Eastern Ontario,
B.C. Children’s Hospital in Vancouver, the Alberta Children’s
Hospital Calgary, London Health Sciences Center, the Children’s
Hospital of Western Ontario in London, the Montreal Children’s
Hospital, Sainte Justine Hospital in Montreal and the IWK Health
Centre in Halifax.
“Our findings have potential implications for
treating not just children with bronchiolitis, but also many
other young children with multiple wheezy episodes,” said
Johnson, a Professor of Pediatrics at the University of Calgary.
“One in three children have at least one wheezy episode before
their third birthday. We anticipate insights from our study will
lead to follow-up studies that may ultimately improve how we
care for all these children.”
