A controlled trial of methylprednisolone in the early emergency department treatment of acute asthma in children.

Asthma continues to be a leading cause for pediatric hospitalizations. A study using high-dose intravenous (i.v.) steroids early in the emergency department (ED) care of adults with acute asthma reported a 60% reduction in hospitalization rate. Limited data are available for children. We hypothesized that the addition of early administration of high-dose methylprednisolone (MP) in routine ED care of asthmatic children would reduce the need for hospitalization by 50%. Eighty-eight children with asthma, aged four to 18 years, were enrolled into a prospective, randomized, double-blind, placebo-controlled study of MP given within 45 (mean 23) minutes of arrival to the ED. After initial evaluation, children received either 2 mg/kg of MP IV or an equivalent amount of placebo (P). Patients then received the usual ED management of their acute exacerbation. Groups were similar in age, sex, and severity of illness (by asthma scoring, respiratory rate, and peak flow). ED treatment (number of aerosols and the use of theophylline) was similar for both groups. The mean time to disposition was 2.9 hours. Sixty-four percent of the children were discharged from the ED. No significant differences were found between the admission rates of the MP and P groups (41% MP vs 33% P, P = 0.44, chi 2, 95% CI for decrease in MP vs P groups -28 to +12%). The average hospital stay was shorter for those children treated with MP (79 hours vs 90 hours). We conclude that IV methylprednisolone given as an adjunct to routine ED care of children with acute asthma is unlikely to markedly reduce hospitalization rates.

Factors affecting glycosylated hemoglobin values in children with insulin-dependent diabetes.

In 477 children with IDD treated by conventional methods, GHb (microcolumn chromatography) and a simultaneous random blood glucose concentration were measured over an 18-month period as indicators of metabolic control (once in 61 children, twice in 99, three or more times in 317). The data were analyzed to assess the effects of patient's age, sex, disease duration, and, in a random subgroup of 273, the number of daily insulin injections and insulin dose (U/kg). The mean +/- SEM percent GHb over this period was 11.8 +/- 0.2% and blood glucose concentration 237 +/- 9 mg/dl. Only seven children (1.4%) had a normal GHb value. There was a highly significant correlation between GHb and both age and blood glucose concentration but not with disease duration greater than one year. The correlation with age was present only in the girls. In 416 children evaluated more than once, with a mean duration between initial and most recent evaluations of 11.3 months, GHb remained within +/- 1% of the initial value in 40.5%, decreased in 32.3%, and increased in 24.2%. These data indicate a closer relationship between metabolic control in children with IDD and age of the child, particularly in females, than with disease duration. In our clinic, using conventional therapeutic methods, the ability to improve control over the short term as measured by changes in percent GHb has been quite limited. This study helps to target those IDD children, especially adolescent girls, requiring a more aggressive therapeutic approach.