Asthma is the most prevalent chronic disease in children and constitutes a significant healthcare burden. First-line therapy for acute asthma exacerbations is well established. However, secondary treatments, including intravenous magnesium sulfate (IV-MgSO4), remain variable due to scarcity of data on its efficacy and safety. To assess the effectiveness and safety of IV-MgSO4 as a second line of treatment in managing children with asthma exacerbations. We searched five databases from inception until April 2023 on randomized clinical trials of IV-MgSO4 in children with acute asthma exacerbations. The primary outcomes were hospitalization rate and length, and change in the severity score. Secondary outcomes included percentage increase in peak expiratory flow rate (PEFR), hospital re-admission rate, need and length for pediatric intensive care unit (PICU) treatment, and adverse effects. Meta-analysis was performed for three outcomes with estimated odds ratios (ORs) or mean differences (MDs) and 95% confidence intervals (CIs). Eleven studies met the final criteria. In comparison to control, administration of IV-MgSO4 was associated with a reduced hospitalization risk (OR 0.15; 95%CI: 0.03, 0.73) in four studies, and improvement of lung function (MD 26.77% PEFR; 95%CI: 18.41, 54.79) in two studies. There were no significant differences in the length of stay between groups. Due to heterogeneity, a narrative synthesis of other outcomes was performed. The use of IV-MgSO4 demonstrated a reduction in the hospitalization rate and PEFR improvement in children with asthma exacerbations. Adverse effects were rare. Further well-designed studies are needed to better determine the efficacy and safety profile of IV-MgSO4.

中文翻译：

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静脉注射硫酸镁治疗儿童哮喘急性加重：系统评价与荟萃分析

哮喘是儿童中最常见的慢性疾病，构成重大的医疗负担。哮喘急性发作的一线治疗已十分成熟。然而，由于缺乏有效性和安全性数据，包括静脉注射硫酸镁 (IV-MgSO4) 在内的二次治疗仍然存在差异。评估 IV-MgSO4 作为治疗哮喘急性发作儿童的二线治疗的有效性和安全性。我们检索了从开始到 2023 年 4 月关于 IV-MgSO4 用于哮喘急性发作儿童的随机临床试验的五个数据库。主要结局是住院率和住院时间以及严重程度评分的变化。次要结局包括呼气峰流速 (PEFR) 的增加百分比、再入院率、儿科重症监护病房 (PICU) 治疗的需求和时间以及不良反应。对三个结果进行荟萃分析，并估计比值比 (OR) 或平均差 (MD) 和 95% 置信区间 (CI)。十一项研究符合最终标准。与对照相比，在四项研究中，IV-MgSO4 给药可降低住院风险（OR 0.15；95%CI：0.03，0.73），并改善肺功能（MD 26.77% PEFR；95%CI：18.41， 54.79）在两项研究中。各组之间的住院时间没有显着差异。由于异质性，对其他结果进行了叙述综合。使用 IV-MgSO4 可以降低哮喘急性发作儿童的住院率并改善 PEFR。不良反应很少见。需要进一步精心设计的研究来更好地确定 IV-MgSO4 的功效和安全性。