Glucocorticoid Therapy Examined in Pediatric Patients With Croup

For patients with croup, the use of glucocorticoids improved symptoms at 2 hours, reduced the length of hospital stay, and cut the rate of return visits, according to a study published in the Cochrane Library.

For this updated review, researchers searched various databases for studies that included children 0–18 years of age with croup and examined the effects of glucocorticoid treatment (e.g., beclomethasone, betamethasone, budesonide, dexamethasone, fluticasone, prednisolone) compared with placebo or other drug therapies. Forty-three randomized controlled trials (N=4565) were included in the analysis, 5 more than in the previous review.

Results showed that the use of glucocorticoids improved croup symptoms at 2 hours (standardized mean difference (SMD) ‐0.65, 95% CI ‐1.13 to ‐0.18; N=426; moderate quality evidence), and this effect lasted for ≥24 hours (SMD ‐0.86, 95% CI ‐1.40 to ‐0.31; N=351; low quality evidence), compared with placebo. In addition, glucocorticoid use was associated with a reduced rate of return visits and/or readmissions (risk ratio 0.52, 95% CI 0.36 to 0.75; N=1679; moderate quality evidence) and a shortened length of hospital stay (MD ‐14.90 hours, 95% CI ‐23.58 to ‐6.22; N=476).

With regard to safety, most of the adverse events reported were not serious (e.g., emotional distress, hyperactivity, vomiting); 4 studies reported secondary infections (e.g., pneumonia, ear infection), but these were rare.

“Our conclusions have changed, as the previous version of this review reported that glucocorticoids reduced symptoms of croup within 6 hours,” the authors noted, adding that “uncertainty remains with regard to the optimal type, dose, and mode of administration of glucocorticoids for reducing croup symptoms in children.”

For more information visit CochraneLibrary.com.