Adjunctive systemic corticosteroids in pediatric orbital cellulitis: a systematic review and meta-analysis

Area of Science:

• Pediatric infectious diseases
• Ophthalmology
• Critical care medicine

Background:

• Orbital cellulitis is a severe pediatric infection with potential vision- and life-threatening complications.
• The use of systemic corticosteroids alongside antibiotics for orbital cellulitis in children is common but lacks definitive evidence regarding efficacy and safety.

Purpose of the Study:

• To systematically review and meta-analyze the effectiveness and safety of adjunctive systemic corticosteroids in pediatric patients hospitalized with orbital cellulitis.

Main Methods:

• A PRISMA-compliant systematic review and meta-analysis included randomized and observational studies.
• Studies compared corticosteroid plus antibiotics versus antibiotics alone in children (<21 years).
• Outcomes assessed included length of stay, surgical intervention, PICU admission, and 30-day readmission.

Main Results:

• Six studies (n=11,803) were included; corticosteroid use did not significantly reduce length of stay.
• Corticosteroid use was associated with increased risks of surgery (RR 2.08), PICU admission (RR 1.82), and 30-day readmission (RR 2.53).
• Evidence certainty was low to moderate, primarily due to observational data.

Conclusions:

• Adjunctive corticosteroids in pediatric orbital cellulitis did not demonstrate benefits in reducing hospitalization duration.
• Potential increased risks of adverse outcomes, including surgery and readmission, were observed.
• High-quality pediatric randomized controlled trials are necessary to clarify the role of corticosteroids in managing orbital cellulitis.