Journal club Pooja Sachdev

Clinical case 4 month old 2 day history of coryzal symptoms, decreased feeding and increased WOB this morning Bilateral wheeze and crepitation's on exam Diagnosis Bronchiolitis –Supportive Management –O2 –Hydration

Background Leading cause of hospital admissions in the first year (21% in the USA). Mainstay of treatment is supportive. Fluid replacement required in 1 in 3 Nasogastric and intravenous hydration both used Potential advantages of NG feeding

No trial has compared methods of hydration in infants admitted to hospital. Aim to compare the 2 methods in previously healthy infants admitted with bronchiolitis.

Published online December 21, 2012

PICO PopulationPreviously well Infants with bronchiolitis InterventionNasogastric hydration ComparisonIntravenous hydration OutcomeLength of hospital stay

Methods Randomized trial in Australia and New Zealand 3 Bronchiolitis seasons ( ) PREDICT Research Network 8 weeks-12 months Exclusion criteria

Trial profile

CASP Is the trial valid? What are the results? Will the results help locally?

Are the results of the trial valid? Did the trial address a clearly focused issue? Was the assignment of patients to treatments randomized? Were the groups similar at the start of the trial? Were all of the patients who entered the trial properly accounted for at its conclusion? Were patients analysed in the groups to which they were randomised? Aside from the experimental intervention, were the groups treated equally? Were patients, health workers and study personnel ‘blind’ to treatment? YesCant’ TellNo

Demographics and clinical features

What are the results? How large was the treatment effect? How precise was the estimate of treatment effect? Were all clinically important outcomes considered? Are the benefits worth the harms and costs? YesCant’ TellNo

Results

Will the results help locally? Can the results be applied to the local population? YesCant’ TellNo

Conclusion Both are appropriate means to hydrate infants with bronchiolitis. NG requires fewer attempts and has a higher success rate of insertion.