Ann Trop Paediatr
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Randomized Controlled Trial Comparative Study Clinical Trial
The role of bronchodilators in the management of bronchiolitis: a clinical trial.
A randomized clinical trial was conducted on young children with bronchiolitis admitted to hospital with moderate illness to determine the efficacy of the bronchodilators Salbutamol and ipratropium bromide, either as a single drug or in combination, given as a nebulized solution, compared with a normal saline placebo. Eighty-nine patients, aged from 23 days to 11 months, were randomized into four groups, depending on administered drug or placebo, as follows: group 1--Salbutamol (n = 20); group 2--ipratropium bromide (n = 23); group 3--combined Salbutamol and Ipratropium bromide (n = 24); group 4--normal saline (n = 22). The groups were identical with respect to age, sex, family history of atopy, respiratory syncytial virus (RSV) positivity and enrollment score. ⋯ The same finding was also noted in children aged more than 3 months (p = 0.35) and in those positive for RSV infection (p = 0.18). The lengths of hospitalization in the four groups were also similar (p = 0.79). It is concluded that there is no role for the nebulized bronchodilators Salbutamol and Ipratropium bromide, either as a single agent or in combination, compared with normal saline placebo in treating young children in hospital with bronchiolitis.
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The use of an air enema in the diagnosis and reduction of intussusception, using a simple home-made device, was prospectively studied in 36 children with the tentative diagnosis of intussusception. Plain abdominal films were inconclusive in 19 patients (53%). Using an air enema, the diagnosis of intussusception was easily reached or excluded in all suspected cases. ⋯ Pneumatic reduction was successful in 23 cases (79%), and reduction was completed within 2-3 minutes in all successfully reduced cases. At operation, three children had a tear of the sero-muscular layer of the transverse colon, but there were no perforations or recurrences of the intussusception in the immediate post-reduction or follow-up period (1-25 months). An air enema is a safe, cheap, clean and reliable procedure for the diagnosis and reduction of intussusception, and can now be considered as the treatment of choice in uncomplicated intussusception.