tailieunhanh - Evidence based pediatrics - part 4

Corticosteroid, được đưa ra bởi các tuyến đường tiêm bắp hoặc tiêm tĩnh mạch, đã được chứng minh là có hiệu quả trong việc quản lý của đợt kịch phát hen suyễn cấp tính trẻ, Scarfone 82 và các đồng nghiệp đã chứng minh rằng, so với giả dược, uống nhập viện giảm prednisolon | 132 Evidence-Based Pediatrics Corticosteroids given by the intramuscular or intravenous route have been shown to be efficacious in the management of acute asthma exacerbations in young 82 Scar-fone and colleagues demonstrated that compared with placebo oral prednisolone reduced hospitalization A meta-analysis combining adult and pediatric studies concluded that there is no evidence to suggest that one route improves pulmonary function more than the Barnett and colleagues designed a double-blind RCT to specifically address this Forty-nine patients aged 18 months to 18 years who presented to the emergency department with moderate to severe asthma exacerbation were enrolled in the trial. They were randomized to receive oral methylprednisolone or intravenous methylprednisolone 30 minutes after the initial treatment with nebulized beta2-agonists. All patients received frequent high-dose nebulized beta2-agonists. They were also treated with intravenous aminophylline. There were no differences between the groups in any of the outcomes measured at 4 hours after treatment. The principal outcome was hospital admission and 48 percent of the oral group were admitted compared with 50 percent of the intravenous group p .88 . The relatively high admission rates in both groups may reflect the severity of the illness in the patients enrolled in the study. The results of this study suggest that the administration of corticosteroids by the oral route is as efficacious as by the intravenous route in children with acute asthma. Oral administration offers several advantages over the IV or IM routes particularly in the pediatric age group as it is painless and less frightening for children. Short courses of oral corticosteroids are recommended in asthma guidelines for adults and children. In children the recommended dose of prednisolone or an equivalent is 1 to 2 mg per kg once daily maximum 40 to 60 mg .12 14 A recent study has been conducted to