Ms. Hester is Content Specialist with Contemporary OB/GYN and Contemporary Pediatrics.

Miranda Hester

Intravenous magnesium has been used to decrease hospitalizations because of refractory acute asthma, although it does have some safety concerns. A 

 looks at whether using nebulized magnesium in the emergency department could be effective in reducing hospitalization among children who were in moderate or severe respiratory distress after being administered evidence-based standardized initial therapy.

The investigators ran a randomized double-blind parallel-group clinical trial from September 2011 to November 2019 in 7 tertiary-care pediatric emergency departments across Canada. Each participant was an otherwise healthy child aged 2 to 17 years who had moderate to severe asthma as defined by a Pediatric Respiratory Assessment Measure score of 5 or greater following standard treatment. Standard treatment was a 1-hour treatment with an oral corticosteroid and 3 inhaled albuterol and ipratropium treatments.

A total of 818 met criteria and volunteered to participate with 2 dropping out, 409 of the children were given magnesium and 407 received a placebo. Following the emergency department, 178 of the 409 children administered magnesium were hospitalized versus 194 of the 407 children who were given placebo (difference, −4.2%; absolute risk difference 95% [exact] CI, −11% to 2.8%); 

 = .26). No significant between-group differences changes were seen from baseline to 240 minutes in the Pediatric Respiratory Assessment Measure score (difference of changes, 0.14 points [95% CI, −0.23 to 0.50]; 

 = .46); respiratory rate (0.17 breaths/min [95% CI, −1.32 to 1.67]; 

 = .82); oxygen saturation (−0.04% [95% CI, −0.53% to 0.46%]; 

 = .88); systolic blood pressure (0.78 mm Hg [95% CI, −1.48 to 3.03]; 

 = .50); or mean number of additional albuterol treatments (magnesium: 1.49, placebo: 1.59; risk ratio, 0.94 [95% CI, 0.79 to 1.11]; 

 = .47). The adverse event of either nausea/vomiting or sore throat/nose happened in 17 of the children who were given magnesium and 5 of the children who were given the placebo.

The researchers concluded that using nebulized magnesium along with albuterol did not have the impact of reducing hospitalization rate for asthma that would put it in line with intravenous magnesium.

1. Schuh S, Sweeney J, Rumantir M, et al. Asthma treated in the emergency department: a randomized clinical trial. 

. 2020;324(20):2038-2047. doi:10.1001/jama.2020.19839

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A new report looks at whether nebulized magnesium could impact hospitalizations due to asthma.

 Can nebulized magnesium reduce hospitalizations because of asthma?

The ear exam is one of the components of every visit to the pediatrician. It can determine ear infections and help lead to a hearing loss diagnosis.



 sat down with Andrew Schuman, MD, FAAP, to discuss the ear exam, hearing loss, and when to refer to audiology.

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Contemporary Pediatrics sat down with Andrew Schuman, MD, FAAP, to discuss the ear exam, hearing loss, and when to refer to audiology. 

Tackling the ear exam and hearing loss

During the week of Thanksgiving, as many Americans travel or host dinners for both small and large groups, the Infectious Disease Society of America issued priority guidance, italicizing the safety measures that have helped people remain safe since the pandemic’s start in the United States: social distance, wash hands, use a mask, and reduce exposure to others.

The webcast, which aired Monday morning, November 23, included discussion of monoclonal antibodies, which have become a hot topic in COVID-19 treatment following the emergency use authorization from the US Food and Drug Administration for casirivimab and imdevimab over the weekend. Adarsh Bhimraj, MD, FIDSA, associate staff physician in the Department of Infectious Diseases at the Cleveland Clinic, in Ohio, and Rajesh T. Gandhi, MD, FIDSA, professor of medicine at Harvard Medical School in Boston, Massachusetts, both highlighted that the data for the efficacy of monoclonal antibodies are still in the early days of study, but the information coming in from the early studies appears to be positive. Gandhi also stressed that as of right now, only dexamethasone has been shown to improve survival.

During the question session of the webcast, Gandhi also spoke about the COVID-19 vaccine news. Earlier that morning, AstraZeneca had announced that their COVID-19 vaccine candidate AZD1222 was 70% effective on average. Unlike the Pfizer/BioNTech and Moderna vaccines, which are mRNA vaccines, AZD1222 uses a virus vector. Gandhi highlighted the fact that the vaccine appeared to reduce asymptomatic infections, which would be a key way to stop the spread of COVID-19, as asymptomatic cases have helped spur the spread.

Both Bhirmaj and Gandhi said that they felt more optimistic now than they did in the early days of the pandemic, thanks to greater understanding of the virus as well as the vaccine news. However, flattening the curve should still be the goal, especially as hospitals deal with the current surge and the country closes in on multiple effective vaccines.

Infectious Disease Society of America offered a look at the current treatment options for COVID-19 and stressed the need to maintain precautions to keep people safe.

“Stay home” to improve COVID-19 numbers

 the interim analysis of their Phase 3 study of their COVID-19 vaccine candidate, BNT162b2.

 The Phase 3 study had 43,538 participants with 42% having a diverse background. During the course of the study, no serious safety issues have been found. There have been 94 confirmed cases of COVID-19 in the cohort and current analysis of the candidate shows that it is more than 90% effective in preventing COVID-19.

The trial will continue until there have been a total of 164 confirmed cases of COVID-19 in the participants. Additionally, the trial will look at whether the candidate can give protection to people who have had previous exposure to COVID-19. The safety data needed to meet the requirements for an Emergency Use Authorization by the US Food and Drug Administration will be available by the end of the third week in November. Participants will be monitored for safety concerns and long-term protection for 2 more years.

Pfizer indicates that 50 million doses of the vaccine would be produced in 2020 and 1.3 billion in 2021.

1. Pfizer. Pfizer and BioNTech announce vaccine candidate against COVID-19 achieved success in first interim analysis from phase 3 study. Pfizer.com. Published November 9, 2020. Accessed November 9, 2020. 

https://www.pfizer.com/news/press-release/press-release-detail/pfizer-and-biontech-announce-vaccine-candidate-against

Pfizer and BioNTech have released interim information on their Phase 3 COVID-19 vaccine trial.

Miranda Hester

Articles

Can nebulized magnesium reduce hospitalizations because of asthma?

Tackling the ear exam and hearing loss

“Stay home” to improve COVID-19 numbers

Pfizer, BioNTech say COVID-19 vaccine is more than 90% effective