Alexis Hamelink, PharmD
Pharmacy Resident
Norton Children's Hospital, United States
Disclosure information not submitted.
Taryn Scott, PharmD, BCPPS
PICU Clinical Specialist
Norton Children's Hospital, United States
Disclosure information not submitted.
Lisa Infanti, PharmD, BCCCP
PICU Pharmacist
Norton Children's Hospital, United States
Disclosure information not submitted.
.jpg "John Berkenbosch, MD, FAAP,FCCM photo")
John Berkenbosch, MD, FAAP,FCCM
Professor of Pediatrics/Pediatric Critical Care
Norton Children's Hospital
Louisville, Kentucky
Disclosure information not submitted.
Title: Safety and Efficacy of Magnesium Sulfate Bolus in Pediatric Patients with Bronchiolitis
Introduction: Bronchiolitis is a common cause for hospitalization in infants. While magnesium sulfate has a long track record of use for pediatric asthma, experience in bronchiolitis is limited. We review our experience with magnesium boluses in bronchiolitis.
Methods: We reviewed charts of patients less than or equal to 12 months of age admitted to our institution’s pediatric intensive care unit with a diagnosis of bronchiolitis who received a magnesium bolus (50mg/kg with a maximum of 2000mg) for respiratory distress. Data collected included ventilatory support, ventilator days, hospital length of stay, viral PCR results, need for ECMO and duration, maximal FiO2 support and incidence of adverse effects. Changes in FiO2, ventilator status and nasal cannula flow rates one hour prior and 6 hours after magnesium administration were recorded.
Results: A total of 43 doses of magnesium sulfate were given to 28 patients. The cohort consisted of an equal number of males and females with a mean age of 6.5 months. 24 of the 28 patients had a positive viral PCR on nasopharyngeal swab, most commonly respiratory syncytial and rhinovirus. Mean ventilator days was 23.3 (n=16) with a mean PICU length of stay of 33.9 days. In the majority of our patients, no change was reported in ventilatory support status, FiO2 requirement or cannula flow rates following magnesium sulfate administration. 6 patients experienced mild hypotension after magnesium administration, none requiring intervention.
Conclusions: Consistent with current literature, a single bolus of intravenous magnesium sulfate had no apparent effect on respiratory status for most of our patients. As a retrospective study, however, other effects such as improved work of breathing were unable to be assessed. That adverse effects were uncommon and mild is encouraging. Further, more rigorous evaluation of the impact of magnesium in this population is warranted.