Systemic corticosteroids in infant bronchiolitis: A meta-analysis

Objective. To determine whether corticosteroids are efficacious in treating bronchiolitis in hospitalized infants. Methods. Online bibliographic databases (Medline, Embase, and Cochrane Clin ical Trials Registry) were searched for: 1) bronchiolitis or respiratory sy ncytial virus, and 2) corticosteroid or glucocorticoid or steroidal antiinf lammatory agents or adrenal cortex hormones. Reference lists from all selec ted articles were also examined. Randomized, placebo-controlled trials of s ystemic corticosteroids in treatment of infants hospitalized with bronchiol itis were selected by 2 investigators. Of 12 relevant publications identifi ed in the literature search, 6 met the selection criteria and had relevant data available. Investigators independently extracted data for 3 outcomes: length of stay (LOS), duration of symptoms (DOS), and clinical scores. Results. In the pooled analysis, infants who received corticosteroids had a mean LOS or DOS that was .43 days less than those who received the placebo treatment (95% confidence interval: -.81 to -.05 days). The effect size fo r mean clinical score was -1.60 (95% confidence interval: -1.92 to -1.28), favoring treatment. Secondary analyses of mean LOS or DOS were performed on 5 trials that had clearly identified methods of randomization, 5 trials th at measured LOS, and 4 trials that clearly excluded infants with previous w heezing. The estimates of effect were similar to the primary analysis but w ere not statistically significant. Conclusions. Combined, published reports of the effect of systemic corticos teroids on the course of bronchiolitis suggest a statistically significant improvement in clinical symptoms, LOS, and DOS.