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  • Recommendations for minimising and monitoring adverse effects of long-term supraphysiological corticosteroid use in children and young persons

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Medicines update
Recommendations for minimising and monitoring adverse effects of long-term supraphysiological corticosteroid use in children and young persons
  1. Claudine Micallef1,
  2. Shveta Chana2
  1. 1 Paediatrics, Oxford University Hospitals NHS Foundation Trust, Oxford, UK
  2. 2 Paediatrics, Milton Keynes University Hospital, Milton Keynes, UK
  1. Correspondence to Dr Claudine Micallef, Oxford University Hospitals NHS Foundation Trust, Oxford OX3 9DU, UK; claudine.micallef2{at}nhs.net

https://doi.org/10.1136/archdischild-2023-325402

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    KEY POINTS

    • Supraphysiological systemic corticosteroids are used commonly in the management of various medical conditions including in children and young persons. These have several side-effects with growth suppression and pubertal delay being specific to this population.

    • Prior to initiating long-term corticosteroids, it is important to take a detailed history and do a physical examination including growth and nutritional statuses, blood pressure and pubertal staging, and do baseline blood investigations as listed in the main text.

    • Although the risks cannot be eliminated completely, there are multiple strategies a clinician can adopt to help reduce these.

    • Monitoring for adverse effects would include assessments of growth and pubertal staging, hypothalamic–pituitary–adrenal axis, bone health, blood glucose, blood pressure and ophthalmological examinations.

    Introduction

    The mother of a 4-year-old boy with a history of nephrotic syndrome presents to the Paediatric Assessment Unit in view of three consecutive urine dip stick tests positive for protein. You discuss that this indicates a relapse and that her child will need to restart systemic corticosteroids. The mother expresses concerns as her child finished a prolonged course of corticosteroids only 3 months ago and has heard that prolonged and/or repeated use of these comes with multiple potentially significant side-effects including stunting of growth. She asks if there are ways to minimise or prevent these risks, and if anything will be done to monitor them.

    Supraphysiological doses of corticosteroids are used in the management of various medical conditions in children and young persons (CYP), but guidance on how to minimise and monitor adverse effects is limited in this population. There are also side-effects that are specific to CYP, and as such require special monitoring.

    The aim of this article is to provide reasonable guidance that is extrapolated from the limited literature on this topic that is specific to CYP. It will not provide a comprehensive review …

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    Footnotes

    • Contributors CM performed the search for the review, which was supervised by SC.

    • Funding The authors have not declared a specific grant for this research from any funding agency in the public, commercial or not-for-profit sectors.

    • Competing interests None declared.

    • Provenance and peer review Commissioned; externally peer reviewed.