Safety of corticosteroids in young children with acute respiratory conditions: a systematic review and meta-analysis.
Acute Disease
Administration, Inhalation
Administration, Intravenous
Administration, Oral
Adrenal Cortex Hormones
/ administration & dosage
Asthma
/ drug therapy
Bronchiolitis, Viral
/ drug therapy
Child, Preschool
Croup
/ drug therapy
Dexamethasone
/ administration & dosage
Fluticasone
/ administration & dosage
Glucocorticoids
/ administration & dosage
Growth Disorders
/ chemically induced
Headache
/ chemically induced
Humans
Infant
Injections, Intramuscular
Pneumonia
/ drug therapy
Prednisone
/ administration & dosage
Respiratory Sounds
Respiratory Tract Diseases
/ drug therapy
Respiratory Tract Infections
/ drug therapy
Tremor
/ chemically induced
Vomiting
/ chemically induced
asthma
bronchiolitis
corticosteroids
croup
paediatrics
safety
Journal
BMJ open
ISSN: 2044-6055
Titre abrégé: BMJ Open
Pays: England
ID NLM: 101552874
Informations de publication
Date de publication:
01 08 2019
01 08 2019
Historique:
entrez:
4
8
2019
pubmed:
4
8
2019
medline:
1
9
2020
Statut:
epublish
Résumé
Adverse events (AEs) associated with short-term corticosteroid use for respiratory conditions in young children. Systematic review of primary studies. Medline, Cochrane CENTRAL, Embase and regulatory agencies were searched September 2014; search was updated in 2017. Children <6 years with acute respiratory condition, given inhaled (high-dose) or systemic corticosteroids up to 14 days. One reviewer extracted with another reviewer verifying data. Study selection and methodological quality (McHarm scale) involved duplicate independent reviews. We extracted AEs reported by study authors and used a categorisation model by organ systems. Meta-analyses used Peto ORs (pORs) and DerSimonian Laird inverse variance method utilising Mantel-Haenszel Q statistic, with 95% CI. Subgroup analyses were conducted for respiratory condition and dose. Eighty-five studies (11 505 children) were included; 68 were randomised trials. Methodological quality was poor overall due to lack of assessment and inadequate reporting of AEs. Meta-analysis (six studies; n=1373) found fewer cases of vomiting comparing oral dexamethasone with prednisone (pOR 0.29, 95% CI 0.17 to 0.48; I Evidence suggests that short-term high-dose inhaled or systemic corticosteroids use is not associated with an increase in AEs across organ systems. Uncertainties remain, particularly for recurrent use and growth outcomes, due to low study quality, poor reporting and imprecision.
Identifiants
pubmed: 31375615
pii: bmjopen-2018-028511
doi: 10.1136/bmjopen-2018-028511
pmc: PMC6688746
doi:
Substances chimiques
Adrenal Cortex Hormones
0
Glucocorticoids
0
Dexamethasone
7S5I7G3JQL
Fluticasone
CUT2W21N7U
Prednisone
VB0R961HZT
Types de publication
Journal Article
Meta-Analysis
Research Support, Non-U.S. Gov't
Systematic Review
Langues
eng
Sous-ensembles de citation
IM
Pagination
e028511Subventions
Organisme : CIHR
ID : KRS134306
Pays : Canada
Informations de copyright
© Author(s) (or their employer(s)) 2019. Re-use permitted under CC BY-NC. No commercial re-use. See rights and permissions. Published by BMJ.
Déclaration de conflit d'intérêts
Competing interests: All authors declare funding from CIHR for the submitted work. LH was funded in part by a New Investigator Salary Award from the CIHR. ACP is supported by a Tier II University of Ottawa Research Chair Award. BHR was supported by a Tier I Canada Research Chair in Evidence-based Emergency Medicine from CIHR. The remaining authors have no financial relationships relevant to this manuscript to disclose. DWJ, TPK and ACP are also authors on some of the included studies.
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