IV magnesium sulfate treatment may lead to subsequent hospitalization in children with asthma: JAMA
Researchers studied 816 children and found that receiving intravenous magnesium in the emergency department was linked to subsequent hospitalization among children with asthma, compared with not receiving the therapy.
Ontario, Canada: The administration of intravenous (IV) magnesium sulfate in the emergency department (ED) is recommended for the treatment of refractory pediatric asthma. Now a recent study in JAMA Network Open has shown IV magnesium sulfate to be associated with subsequent hospitalization among children with asthma.
Guidelines have recommended the administration of IV magnesium sulfate for refractory pediatric asthma, despite this, the number of asthma-related hospitalizations has remained stable, and IV magnesium therapy is independently associated with hospitalization.
Against the above background, Suzanne Schuh, University of Toronto, Toronto, Ontario, Canada, and colleagues aimed to examine the association between IV magnesium therapy administered in the ED and subsequent hospitalization among pediatric patients with refractory acute asthma after adjustment for patient-level variables.
For this purpose, the researchers conducted a post hoc secondary analysis of a double-blind randomized clinical trial of children with acute asthma treated from September 26, 2011, to November 19, 2019, at 7 Canadian tertiary care pediatric EDs between September and November 2020. It included 816 otherwise healthy children aged 2 to 17 years with Pediatric Respiratory Assessment Measure (PRAM) scores of 5 points or higher after initial therapy with systemic corticosteroids and inhaled albuterol with ipratropium bromide. They were randomly assigned to 3 nebulized treatments of albuterol plus either magnesium sulfate (40-75 mg/kg) or a 5.5% saline placebo.
The research yielded the following findings:
- 26.3% received IV magnesium, and 88.4% of these children were hospitalized compared with 29.0% who did not receive IV magnesium.
- Multivariable factors associated with hospitalization were IV magnesium receipt from 2011 to 2016 (odds ratio [OR], 22.67) and from 2017 to 2019 (OR, 4.19), use of additional albuterol (OR, 5.94), and increase in PRAM score at disposition (per 1-U increase: OR, 2.24).
- In children with a disposition PRAM score of 3 or lower, receipt of IV magnesium therapy was associated with hospitalization (OR, 8.52).
In this secondary analysis of an RCT, the researchers found that the administration of IV magnesium therapy among children with refractory acute asthma was associated with hospitalization independent of asthma severity and other patient-level characteristics. After adjustment for patient-level characteristics, this association was also evident among children who met the criteria for hospital discharge at the time of ED disposition.
"Future research on the benefit of IV magnesium therapy in reducing hospitalization and the related safety profile may clarify the role of this therapy in refractory pediatric asthma," concluded the authors.
Reference:
The study titled, "Association Between Intravenous Magnesium Therapy in the Emergency Department and Subsequent Hospitalization Among Pediatric Patients With Refractory Acute Asthma: Secondary Analysis of a Randomized Clinical Trial," is published in JAMA Network Open.
DOI: https://jamanetwork.com/journals/jamanetworkopen/fullarticle/2782049
