Dataset Information

Safety of corticosteroids in young children with acute respiratory conditions: a systematic review and meta-analysis.

ABSTRACT:

Objective

Adverse events (AEs) associated with short-term corticosteroid use for respiratory conditions in young children.

Design

Systematic review of primary studies.

Data sources

Medline, Cochrane CENTRAL, Embase and regulatory agencies were searched September 2014; search was updated in 2017.

Eligibility criteria

Children <6 years with acute respiratory condition, given inhaled (high-dose) or systemic corticosteroids up to 14 days.

Data extraction and synthesis

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.

Results

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; I²=0%). The mean difference in change-from-baseline height after one?year between inhaled corticosteroid and placebo was 0.10?cm (two studies, n=268; 95%?CI -0.47 to 0.67). Results from five studies with heterogeneous interventions, comparators and measurements were not pooled; one study found a smaller mean change in height z-score with recurrent high-dose inhaled fluticasone over one?year. No significant differences were found comparing systemic or inhaled corticosteroid with placebo, or between corticosteroids, for other AEs; CIs around estimates were often wide, due to small samples and few events.

Conclusions

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.

SUBMITTER: Fernandes RM

PROVIDER: S-EPMC6688746 | biostudies-literature | 2019 Aug

REPOSITORIES: biostudies-literature

ACCESS DATA

Publications

Safety of corticosteroids in young children with acute respiratory conditions: a systematic review and meta-analysis.

Fernandes Ricardo M RM Wingert Aireen A Vandermeer Ben B Featherstone Robin R Ali Samina S Plint Amy C AC Stang Antonia S AS Rowe Brian H BH Johnson David W DW Allain Dominic D Klassen Terry P TP Hartling Lisa L

BMJ open 20190801 8

<h4>Objective</h4>Adverse events (AEs) associated with short-term corticosteroid use for respiratory conditions in young children.<h4>Design</h4>Systematic review of primary studies.<h4>Data sources</h4>Medline, Cochrane CENTRAL, Embase and regulatory agencies were searched September 2014; search was updated in 2017.<h4>Eligibility criteria</h4>Children <6 years with acute respiratory condition, given inhaled (high-dose) or systemic corticosteroids up to 14 days.<h4>Data extraction and synthesis ...[more]

PMID: 31375615

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Project description:BackgroundGlobally, the respiratory syncytial virus (RSV) is the most common etiologic agent of acute respiratory illnesses in children. However, its burden has not been well addressed in developing countries. We aimed to estimate the molecular epidemiology of RSV in children less than 18 years of age with acute respiratory infections in Africa by conducting a systematic review and meta-analysis.MethodsWe systematically searched PubMed, Scopus, CINAHL, and Global Index Medicus databases to identify studies published from January 1, 2002, to April 27, 2022, following the PRISMA 2020 guideline. We assessed the study quality using the Joanna Brigg's Institute (JBI) critical appraisal checklists. We conducted a qualitative synthesis by describing the characteristics of included studies and performed the quantitative synthesis with random effects model using STATA-14. We checked for heterogeneity with Q statistics, quantified by I2, and determined the prediction interval. We performed subgroup analyses to explain the sources of heterogeneity and assessed publication biases by funnel plots augmented with Egger's test.ResultsEighty-eight studies with 105 139 participants were included in the review. The overall pooled prevalence of RSV in children <18 years of age was 23% (95% confidence interval (CI) = 20, 25%). Considerable heterogeneity was present across the included studies. The adjusted prediction interval was found to be 19%-27%. Heterogeneities were explained by subgroups analyses. The highest prevalence of RSV was found among inpatients, 28% (95% CI = 25, 31%) compared with inpatients/outpatients and outpatients, with statistically significant differences (P < 0.01). The RSV estimate was also highest among those with acute lower respiratory tract illnesses (ALRTIs), 28% (95% CI = 25, 31%) compared with acute upper respiratory tract illnesses (AURTIs) and both acute upper/lower respiratory manifestations, with statistically different prevalence (P < 0.01). RSV infection estimates in each sub-region of Africa were statistically different (P < 0.01). There were no statistically significant differences in RSV infections by designs, specimen types, and specimen conditions, despite them contributing to heterogeneity.ConclusionsWe found a high prevalence of RSV in pediatric populations with acute respiratory tract illnesses in Africa, highlighting that the prevention and control of RSV infections in children deserve more attention.RegistrationPROSPERO CRD42022327054.

Dataset Information

Safety of corticosteroids in young children with acute respiratory conditions: a systematic review and meta-analysis.

Objective

Design

Data sources

Eligibility criteria

Data extraction and synthesis

Results

Conclusions

Publications

Safety of corticosteroids in young children with acute respiratory conditions: a systematic review and meta-analysis.

Similar Datasets

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