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Corticosteroids in Pediatric Septic Shock: A Narrative Review
Immacolata Rulli1, Angelo Mattia Carcione1, Federica D'Amico1
1Neonatal and Pediatric Intensive Care Unit, University Hospital of Messina, 98124 Messina, Italy.
Journal of Personalized Medicine
|December 27, 2024
Summary
Corticosteroid therapy for pediatric septic shock remains controversial, with unclear benefits for mortality and severity. Identifying children with secondary adrenal insufficiency who may benefit requires further research.
Area of Science:
- Pediatric Critical Care Medicine
- Pediatric Endocrinology
- Pharmacology
Background:
- Corticosteroid therapy is a debated treatment for pediatric septic shock.
- Current guidelines offer conditional recommendations, particularly for refractory cases.
Purpose of the Study:
- To review the current literature on corticosteroid efficacy in pediatric septic shock.
- To evaluate impacts on mortality, disease severity, and identify potential patient subgroups.
Main Methods:
- Systematic literature review from 2013-2023.
- Searched PubMed, Medline, Cochrane Library, Scopus using keywords: "septic shock", "steroids", "children".
- Analyzed 63 selected articles from 399 initially identified.
Main Results:
- Evidence on mortality reduction is conflicting; some studies show no benefit or increased mortality.
- Hydrocortisone may reduce ICU stay but has limited impact on ventilation, inotropic support, and organ failure.
- Adrenal function testing lacks reproducibility for identifying steroid responders.
- Common side effects include muscle weakness, hypernatremia, and hyperglycemia.
Conclusions:
- The efficacy of corticosteroids in pediatric septic shock is not definitively established.
- A subset of patients with secondary adrenal insufficiency might benefit, but identification and treatment protocols are undefined.
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