Points and Pearls Digest | Corticosteroid Use in Management of Pediatric Emergency Conditions
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Corticosteroid Use in Management of Pediatric Emergency Conditions

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  • For children hospitalized with asthma, experts recommend oral prednisone/prednisolone at 1 to 2 mg/kg/day (max, 60 mg/day), in 2 divided doses, for 3 to 5 days. For children with asthma who present to the emergency department (ED), 1 to 2 daily doses of oral dexamethasone 0.6 mg/kg have been shown to be equivalent, with better tolerance and compliance.
  • Inhaled corticosteroids are indicated for long-term control of asthma but are not efficacious in acute exacerbations.
  •  Systemic corticosteroids are indicated to improve morbidity and decrease hospitalizations for croup. Oral dexamethasone therapy is preferred, at doses ranging from 0.15 mg/kg to 0.6 mg/kg (these doses have been shown to have equal efficacy).

Most Important References

  • Cross KP, Paul RI, Goldman RD. Single-dose dexamethasone for mild-to-moderate asthma exacerbations: effective, easy, and acceptable. Can Fam Physician. 2011;57(10):1134-1136. (Review)
  • Russell K, Weibe N, Saenz A, et al. Glucocorticoids for croup. Cochrane Database Syst Review. 2004;1: CD001955. (Systematic review; 31 studies, 3767 patients) DOI: http://dx.doi.org/10.1002/14651858.CD001955.pub2
  • Sadeghirad B, Siemieniuk RAC, Brignardello-Petersen R, et al. Corticosteroids for treatment of sore throat: systematic review and meta-analysis of randomised trials. BMJ. 2017;358:j3887. (Systematic review and meta-analysis; 10 trials, 1426 patients) DOI: http://dx.doi.org/10.1136/bmj.j3887
  • Choo KJ, Simons FE, Sheikh A. Glucocorticoids for the treatment of anaphylaxis. Cochrane Database Syst Rev. 2012(4):CD007596. (Systematic review) DOI: http://dx.doi.org/10.1002/14651858.CD007596.pub3
  • Evaniew N, Belley-Cote EP, Fallah N, et al. Methylprednisolone for the treatment of patients with acute spinal cord injuries: a systematic review and meta-analysis. J Neurotrauma. 2016;33(5):468-481. (Systematic review, meta-analysis; 4 randomized controlled trials and 17 observational studies) DOI: http://dx.doi.org/10.1089/neu.2015.4192
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Publication Information
Authors

Asalim Thabet, MD; Tyler Greenfield, DO; Richard M. Cantor, MD, FAAP, FACEP

Peer Reviewed By

Augusta Saulys, MD, FAAP, FACEP; Catherine Sellinger, MD

Publication Date

March 2, 2018

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