Efficacy of Magnesium Sulfate in the Treatment of Bronchiolitis

• On arrival to Pediatric Emergency Center, patients will be attended by a pediatric specialist on call who will take history and perform full physical examination. Patients will be assessed for eligibility to the study based on the inclusion criteria.
• Guardians of eligible patients will be approached with the study design, objectives and risks; Patients will be included after obtaining a verbal and assigned written consent.
• A chest radiograph and Magnesium level in serum will be requested for all study patients upon recruitment.
• The observation physician will complete the data collection sheet that will include the patient's demographics, physical examination, bronchiolitis clinical severity score,oxygen saturation, chest radiograph findings and Magnesium level.
• Treatment will be delivered to enrolled patients as currently practice in PEC(Nebulized epinephrine 1:1000 1ml in 5 ml of 5% hypertonic saline, every 4 hours until discharge, for all patients and if there is history of Bronchial Asthma in mother, father or full sibling. And/or history of Eczema in the Child ,patients will start on dexamethasone 1mg/kg orally stat.(max-10 mg/dose). Then 0,6 mg/kg orally once daily starting from second day of admission for 4 days).
• All patients will be randomized to receive either Magnesium sulfate intravenous single dose over 1 hour or placebo. And it will be given in the same time with currently practice treatment
• Epinephrine nebulization can be given on PRN basis up to a maximum of every one hour, at a dose of 0.5 mg/kg (min 2.5mg/dose and max 5 mg/dose) mixed in 5 ml of 5% hypertonic saline.•
• Bronchiolitis severity score (BSS) will be recorded at 0, 4, 8, 12, 16,20,24,36,48,60,72 hours, and on discharge.
• Vital signs will be recorded at 0, 2, 4 hours and then every 4 hours from the administration of study medication.
• All patients will be followed up for two weeks post discharge by a phone call asking about the general condition, relapse of symptoms, or need for readmission.

Inclusion criteria

Infants 1-18 months of age presenting to Al Saad Pediatric Emergency Center from October 2012 to May 2015 with diagnosis of Bronchiolitis and bronchiolitis clinical severity score > 4,will be include in the study.

Exclusion criteria

• Prematurity (Gestational age 34 weeks or less);
• Previous history of wheezing;
• Use of steroid within 48 hours of presentation;
• CRITICALLY ill patients with one or more of the following:

• obtunded consciousness
• progressive respiratory failure requiring intensive care unit (PICU) admission;
• history of apnea within 24 hours before presentation
• oxygen saturation < 85% on room air at the time of recruitment
• History of chronic lung disease;Chronic lung disease of prematurity Cystic fibrosis;
• Congenital heart disease.
• All immunodeficient children: primary or secondary
• Known hypersensitivity to magnesium sulfate.
• Known to have magnesium or calcium metabolism disturbance. (e.g.; vitamin D deficiency, hypoparathyroidism).