Royal Childrens Hospital, Murdoch Childrens Research Institute
Corticosteroids are used for a vast range of chronic conditions of infancy and childhood, crossing most medical specialties. Whilst they have been of enormous benefit over many years, up to 50 – 60% of recipients have some form of adverse effect, with potentially serious risks, including adrenal suppression, inhibition of linear growth, iatrogenic Cushing syndrome and crush fractures of vertebrae. Dose, modality of administration and duration of action all contribute to risk profile. To address the problem of steroid overuse, pharmacokinetics of different steroids must be recognized, new treatments considered and adequate surveillance undertaken, to reduce associated health problems.
For corticosteroid use in doses and for durations likely to cause adrenal suppression, all should receive advice on emergency and sick day management, with consideration for parenteral hydrocortisone. Education is mandatory for the immunosuppressed and those who have higher potential to become unwell and where poor access to emergency care or hospitalisation exists. IV/IM hydrocortisone should be available for injection under these circumstances.
Management should include a rapid reduction of high dose to physiological replacement level, at a speed to be determined by the underlying condition and care of the primary disorder.
To reduce misuse and overuse of corticosteroids in paediatrics, consideration should be given to careful review of published Cochrane data base analyses, together with seeking possible alternative treatment modalities, via a combined disciplinary discussion with other specialists in attendance and by literature review of current updates.
Adverse effects of multiple modalities of corticosteroid administration will be discussed , with detailed plans for weaning off medication where needed.
Disclaimer: The Views and opinions expressed in the articles are of the authors and not of the journal.
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