IV Magnesium Cuts Pediatric Asthma Hospital Stays - Study Analysis

meta-analysis PMID: 38395640

Quick Summary: Research shows that giving kids with severe asthma an IV of magnesium sulfate in the ER can significantly reduce the need for hospitalization. This study looked at multiple studies to confirm this benefit.

What The Research Found

Giving children with serious asthma attacks an IV of magnesium sulfate in the emergency room can significantly improve their breathing and reduce the chances they'll need to be admitted to the hospital. The study found that kids who got magnesium had better lung function and needed less hospital care.

Study Details

Who was studied: Children aged 2-18 years old who went to the ER with asthma attacks.

How long: The study looked at results within 240 minutes (4 hours) after the magnesium was given.

What they took: Children received an IV of magnesium sulfate (40–50 mg/kg) along with their usual asthma medications.

What This Means For You

If your child has a severe asthma attack that doesn't improve with standard treatments in the ER, IV magnesium sulfate may help them avoid being admitted to the hospital. This could mean less time in the hospital and a quicker return home.

Study Limitations

The study combined data from different studies, and some studies used slightly different methods. Also, the study didn't include children with the most severe asthma cases. More research is needed to determine the best dose for different age groups and levels of asthma severity.

Key Findings

This meta-analysis concluded that intravenous magnesium sulfate (IV-MgSO4) significantly reduces hospital admission rates and improves pulmonary function in children experiencing moderate-to-severe acute asthma exacerbations unresponsive to initial bronchodilator therapy. The primary benefit was observed as a reduced need for hospitalization following emergency department treatment, with statistically significant improvements in clinical asthma scores and forced expiratory volume (FEV₁) within 240 minutes of administration.

Study Design

The study was a systematic review and meta-analysis synthesizing data from randomized controlled trials (RCTs) evaluating IV-MgSO4 in pediatric asthma exacerbations. It included children aged 2–18 years treated in emergency departments. The meta-analysis pooled results from 8 eligible RCTs, totaling 1,124 pediatric participants. Studies compared standard care (inhaled bronchodilators ± corticosteroids) plus IV-MgSO4 versus standard care plus placebo or alternative secondary therapy. Outcomes were assessed within 240 minutes post-administration.

Dosage & Administration

The standard IV-MgSO4 dose across included studies was 40–50 mg/kg (maximum 2 g), administered as a single intravenous infusion over 20–30 minutes. Dosing was weight-based and delivered alongside first-line therapies (salbutamol/ipratropium bromide and systemic corticosteroids).

Results & Efficacy

IV-MgSO4 reduced hospital admission risk by 34% (RR 0.66, 95% CI 0.54–0.81; p<0.001). Mean difference in FEV₁ improvement at 240 minutes was +12.3% (95% CI 8.7–15.9; p<0.001) versus control. Clinical asthma scores showed significantly greater improvement (mean difference -1.8 points, 95% CI -2.4 to -1.2; p<0.001). No significant effect was observed in mild exacerbations. Adverse events (transient flushing, drowsiness) were mild and self-limiting.

Limitations

Heterogeneity existed in asthma severity definitions and concomitant treatments across studies (I²=42% for admissions). Most trials excluded children with life-threatening exacerbations or comorbidities, limiting generalizability to critically ill patients. Publication bias could not be fully excluded. Long-term outcomes and optimal dosing stratification by age/severity were not addressed.

Clinical Relevance

For children with moderate-to-severe asthma exacerbations unresponsive to initial emergency treatment, IV-MgSO4 is a clinically effective secondary intervention that reduces hospitalization likelihood by one-third. This supports its inclusion in emergency protocols for this specific pediatric subgroup. It does not replace first-line therapies but offers a safe, evidence-based option to mitigate healthcare utilization during acute episodes. Practitioners should consider it after standard bronchodilator/corticosteroid failure in eligible patients.