| BackgroundPneumonia is a common illness affecting approximately 450 million people a year and occurring in all parts of the world.It is a major cause of death among all age groups,resulting in 1.4 million deaths in 2010(7%of the world's yearly total).Each year,pneumonia kills more than 4 million people and causes illness in millions more around the world.In developed countries,pneumonia primarily affects elderly persons.However,half of pneumonia-related deaths worldwide actually occur among children under age five-most of whom live in developing countries.For every child that dies from pneumonia in developed countries,more than 2,000 children die from pneumonia in developing countries Rates are greatest in children less than five and adults older than 75 years of age.However,in recent years,clinicians are consistently applying new combination of regiments with the most recent and controversial one being corticosteroid.The need to clearly understand the clinical significance of corticosteroid in the management severe pneumonia in pediatric intensive care patients is urgent as the use of corticosteroid as adjunct therapy in pneumonia is on the rise.OBJECTIVETo determine if systemic corticosteroid therapy is associated with improved outcomes particularly length of hospital stay amongst children hospitalized with severe pneumonia(SP).METHODSIn this stratified retrospective cohort study,we used data from 113 patients of the intensive care unit.The age range were 2 months to 8 years with SP.Main outcome measures were length of stay(LOS),readmission.The primary exposure was the use of adjunct systemic corticosteroids(methylprednisolone).Patients were considered to have severe pneumonia from diagnosis at admission.The patients were categorized into test group methylprednisolone group and those without methylprednisolone in their regiment.Treatment began immediately within hospital admission and lasted till the patient was discharged.The researchers monitored the patient's length of hospital stay,composite outcome of late treatment failure,in-hospital mortality and readmission within 30 days from day of discharge.Treatment failure was defined as development of shock,need for ventilation,or death within 72 hours of treatment initiation.Analyses were performed using GraphPad Prism 6 software and SPSS Statistics(?)23.Ink,New York,USA).P value<0.05(two-tailed)was considered as significant.RESULTSThe 113 patients whose data were included were all diagnosed of severe pneumonia.Adjunct corticosteroid therapy was administered to 58(51.3%)while 55 patients(48.7%)did not receive corticosteroid.The mean LOS was 7.3 and 11 days respectively for corticosteroid patient and non-corticosteroid patients,and no patients required readmission.Systemic corticosteroid therapy was associated with longer LOS overall compare with non-corticosteroid group P=0.001.However,there was no statically significant between the two groups' Pediatric critical score index p=0.109.In hospital mortality was generally lower amongst the corticosteroid group 8(13.8%)compared to non-corticosteroid group 11(20%).A stratified analysis of in hospital mortality showed the following ANV +GLU 1(4.5%)ANV+AB+GLU 1(7.69%)ANV+OSE+GLU 6(26.1%)ANV only 5(27.7%)ANV+AB 3(12.5%)ANV +OSE +AB 1(7.69%)respectively,thus showing variation in the outcome.However,the size of the sample in the stratified analysis was few and could not be correlated.CONCLUSIONFor children hospitalized with SP,adjunct corticosteroids were generally associated with a shorter hospital stay(LOS)among patients who received concomitant corticosteroid therapy compare to those who did not receive corticosteroids.This result is inconsistent with previous findings.However,given the stratified nature of this study and the small sample size the stratified analysis could not be correlated.There is need to conduct additional study with bigger sample size considering different parameter and drugs-drug interaction as well as the systemic effects of. |
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