Intravenous Magnesium in ED Linked to Hospitalization for Pediatric Asthma

Pediatric hospitalization, child in hospital bed
Pediatric hospitalization, child in hospital bed
Researchers investigated whether use of intravenous magnesium therapy for children with asthma was linked to subsequent hospitalization of these children.

The administration of intravenous (IV) magnesium to children with asthma being treated in the emergency department (ED) was found to be associated with subsequent hospitalization, according to study findings published in JAMA Network Open.

Although guidelines recommend the use of IV magnesium sulfate for refractory asthma in pediatric patients, the number of hospitalizations linked to asthma have remained stagnant. In addition, IV magnesium has been independently linked to hospitalization.

A team of investigators in Canada conducted a post hoc secondary analysis of a double-blind randomized clinical trial ( Identifier: NCT01429415) to characterize the association between the administration of IV magnesium sulfate in the ED and subsequent hospitalization in pediatric patients with refractory acute asthma.

The analysis was adjusted for patient-level variables, some of which included year epoch at enrollment, receipt of IV magnesium, Pediatric Respiratory Assessment Measure (PRAM) score (after initial therapy and at ED disposition), age, and sex.

Of the 816 patients (median age 5 years; 63.4% boys) included in the study population for the initial randomized controlled trial, 364 patients (44.6%) were hospitalized for asthma at the index ED visit; 452 patients (55.4%) were discharged home from the ED.

In the ED, 215 children (26.3%) received IV magnesium, 190 of whom were hospitalized. Patients treated with IV magnesium had a higher Pediatric Respiratory Assessment Measure (PRAM) score (6.7 points) after initial stabilization therapy compared with those not treated with IV magnesium (6.0 points). Patients treated with IV magnesium also had a higher likelihood of previous admissions to the intensive care unit for asthma.

The overall hospitalization rate ranged from 28.3% to 60.5% for children with acute asthma among participating EDs. Children in the ED who received IV magnesium had nearly 10 times greater odds of being hospitalized compared with children who did not receive IV magnesium (odds ratio [OR], 9.76; P <.001).

Hospitalization following IV magnesium treatment was associated with the year epoch of presentation with an adjusted odds of hospitalization of 22.67 from 2011 to 2016; however, odds of hospitalization among this cohort from 2017 to 2019 was 4.19. “Therefore, the odds of hospitalization after IV magnesium decreased approximately 5-fold over time,” the authors noted.

In adjusted analyses, PRAM scores measured at ED disposition (OR, 2.24; P <.001) and albuterol treatment administered after the completion of experimental therapy (OR, 5.94; P <.001) were independently linked to hospital admission.

“[W]e 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,” the authors noted.

“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 investigators.

Disclosure: Multiple authors declared affiliations with industry. Please refer to the original article for a full list of disclosures.


Schuh S, Freedman SB, Zemek R, et al; for the Pediatric Emergency Research Canada. 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. JAMA Netw Open. Published online July 19, 2021. doi:10.1001/jamanetworkopen.2021.17542