Department of Pediatric Pulmonology, Erasmus Medical Centre, Sophia Children’s Hospital, Rotterdam, the Netherlands
Correspondence to: Peter Merkus, MD, PhD, Department of Pediatric Pulmonology, Erasmus Medical Centre, Sophia Children’s Hospital, PO Box 2060, 3000 CB Rotterdam, the Netherlands; e-mail: firstname.lastname@example.org
With interest we read the publication of Picard et al,1 who demonstrated that the prevalence of postbronchoscopic fever in children can be reduced by administration of dexamethasone. The study is well designed, and the results are convincing. We agree that postbronchoscopic fever is uncomfortable, occurs frequently, and sometimes causes distress with parents and physicians. However, one could argue that administration of 0.5 mg/kg of dexamethasone to avoid such distress is not necessary.
In our practice, we instruct parents that they should expect their child to be a little feverish in the 12 to 24 h following bronchoscopy, that this is normal, and that they only should contact a doctor when the fever persists for > 24 h or the child becomes ill. With that policy, parents contacted us in < 1% of cases (> 600 bronchoscopies in 10 years). Two of these patients were thought to have an infection for which antibiotic treatment was started.
Alternatively, one could prescribe oral antipyretics after the procedure if fever occurs, rather than immunosuppressing drugs. There is no proof that immunosuppression prevents any long-term sequelae, and there remains the small risk of bacteremia, especially in patients with chronic lung disease or immunologic disorders.2
The authors have no conflicts of interest to disclose.
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