BENEFICIAL EFFECT OF INTRAVENOUS DEXAMETHASONE IN CHILDREN WITH MILD TO MODERATELY SEVERE ACUTE CHEST SYNDROME COMPLICATING SICKLE-CELL DISEASE

Acute chest syndrome (ACS) in patients with sickle cell disease (SCD) has historically been managed with oxygen, antibiotics, and blood tran sfusions, Recently high-dose corticosteroid therapy was shown to reduc e the duration of hospitalization in children with SCD and vaso-occlus ive crisis. Therefore, we chose to assess the use of glucocorticolds i n ACS, We conducted a randomized, double-blind placebo-controlled tria l to evaluate the efficacy and toxicity of intravenous dexamethasone ( 0.3 mg/kg every 12 hours x 4 doses) in children with SCD hospitalized with mild to moderately severe ACS. Forty-three evaluable episodes of ACS occurred in 38 children (median age, 6.7 years). Twenty-two patien ts received dexamethasone and 21 patients received placebo. There were no statistically significant differences in demographic, clinical, or laboratory characteristics between the two groups. Mean hospital stay was shorter in the dexamethasone-treated group (47 hours v 80 hours; P = .005). Dexamethasone therapy prevented clinical deterioration and reduced the need for blood transfusions (P < .001 and = .013, respecti vely). Mean duration of oxygen and analgesic therapy, number of opioid doses, and the duration of fever was also significantly reduced in th e dexamethasone-treated patients. Of seven patients readmitted within 72 hours after discharge (six after dexamethasone; P = .095), only one had respiratory complications (P = 1.00). No side effects clearly rel ated to dexamethasone were observed. In a stepwise multiple linear reg ression analysis, gender and previous episodes of ACS were the only va riables that appeared to predict response to dexamethasone, as measure d by lengh of hospital stay, Intravenous dexamethasone has a beneficia l effect in children with SCD hospitalized with mild to moderately sev ere acute chest syndrome, Further study of this therapeutic modality i s indicated. (C) 1998 by The American Society of Hematology.