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Original Research |

Intravenous magnesium sulfate for bronchiolitis: A randomized trial

Khalid Alansari, MD, FRCPC, FAAP(PEM); Rafah Sayyed, MD; Bruce L. Davidson, MD, MPH; Shahaza Al Jawala, MD; Mohamed Ghadier, MD
Author and Funding Information

Funding source: This study was hospital-sponsored by Hamad Medical Corporation.

Conflict of interest: The authors have no conflict of interest or financial relationships to disclose. No form of payment was given to anyone to produce the manuscript.

Clinical Trial Registration:www.clinicaltrials.gov (identifier NCT02145520)

1Division of Pediatric Emergency Medicine, Department of Pediatrics, Hamad Medical Corporation

2Weill Cornell Medical College, Doha, Qatar

3Division of Pediatric Emergency Medicine, Department of Pediatrics, Sidra Medical and Research Center

4Pulmonary and Critical Care Medicine Division, University of Washington School of Medicine, Seattle, Washington

Correspondence to: Khalid Alansari, MD, Department of Pediatrics, Division of Pediatric Emergency Medicine, Hamad Medical Corporation, PEC Al Saad, Sidra Medical and Research Centre, P.O. Box- 3050, Doha, Qatar.


Copyright 2017, . All Rights Reserved.


Chest. 2017. doi:10.1016/j.chest.2017.03.002
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Published online

Abstract

Background  To determine if intravenous magnesium, useful for severe pediatric asthma, reduces time to medical readiness for discharge in bronchiolitis patients when added to supportive care

Methods  We compared a single dose of 100 mg/kg intravenous magnesium sulfate versus placebo for acute bronchiolitis. Patients received bronchodilator therapy, nebulized hypertonic saline, and 5 days of dexamethasone if there was eczema and/or a family history of asthma. Time to medical readiness for discharge was the primary efficacy outcome. Bronchiolitis severity scores and need for infirmary or hospital admission and for clinic revisits within 2 wk were secondary outcomes. Cardiorespiratory instability onset was the safety outcome.

Results  162 previously healthy infants diagnosed with bronchiolitis aged 22 days to 17.6 months, median 3.7 months, were enrolled. About half had eczema and/or a family history of asthma. 86.4% had positive nasopharyngeal virus swabs. Geometric mean time until medical readiness for discharge was 24.1h (95% CI, 20.0-29.1) for the 78 magnesium patients and 25.3h (95% CI, 20.3-31.5) for the 82 placebo patients (ratio 0.95; 95% CI,0.52-1.80, p=0.91). Mean bronchiolitis severity scores over time were similar for the two groups. The frequency of clinic visits in the subsequent 2 wk, 33.8% and 27.2%, respectively, was also similar. Fifteen (19.5%) magnesium versus 5 (6.2%) placebo patients were readmitted to infirmary or hospital within 2 wk (p= 0.016). No acute cardiorespiratory side effects were reported.

Conclusions  Intravenous magnesium did not provide benefit for patients with acute bronchiolitis and may be harmful.


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