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Blood, Vol. 92 No. 9 (November 1), 1998:
pp. 3082-3089
Beneficial Effect of Intravenous Dexamethasone in Children
With Mild to Moderately Severe Acute Chest Syndrome Complicating Sickle
Cell Disease
Juan Carlos Bernini,
Zora R. Rogers,
Eric S. Sandler,
Joan S. Reisch,
Charles T. Quinn, and
George R. Buchanan
From the Department of Pediatrics and Academic Computing Service, The
University of Texas Southwestern Medical Center at Dallas and Center
for Cancer and Blood Disorders, Children's Medical Center, Dallas, TX.
Acute chest syndrome (ACS) in patients with sickle cell disease
(SCD) has historically been managed with oxygen, antibiotics, and blood
transfusions. Recently high-dose corticosteroid therapy was shown to
reduce the duration of hospitalization in children with SCD and
vaso-occlusive crisis. Therefore, we chose to assess the use of
glucocorticoids in ACS. We conducted a randomized, double-blind
placebo-controlled trial to evaluate the efficacy and toxicity of
intravenous dexamethasone (0.3 mg/kg every 12 hours × 4 doses) in
children with SCD hospitalized with mild to moderately severe ACS.
Forty-three evaluable episodes of ACS occurred in 38 children (median
age, 6.7 years). Twenty-two patients received dexamethasone and 21 patients received placebo. There were no statistically significant
differences in demographic, clinical, or laboratory characteristics
between the two groups. Mean hospital stay was shorter in the
dexamethasone-treated group (47 hours v 80 hours; P = .005). Dexamethasone therapy prevented clinical deterioration and
reduced the need for blood transfusions (P < .001 and = .013, respectively). Mean duration of oxygen and analgesic therapy,
number of opioid doses, and the duration of fever was also
significantly reduced in the dexamethasone-treated patients. Of seven
patients readmitted within 72 hours after discharge (six after
dexamethasone; P = .095), only one had respiratory
complications (P = 1.00). No side effects clearly related to
dexamethasone were observed. In a stepwise multiple linear regression
analysis, gender and previous episodes of ACS were the only variables
that appeared to predict response to dexamethasone, as measured by
lengh of hospital stay. Intravenous dexamethasone has a beneficial
effect in children with SCD hospitalized with mild to moderately severe acute chest syndrome. Further study of this therapeutic modality is
indicated.
© 1998 by The American Society of Hematology.
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