-Large Study Shows Benefits Differ from those in Adults-
PHILADELPHIA, May 6 /PRNewswire-USNewswire/ -- Corticosteroids given to
children who are hospitalized for bacterial meningitis do not provide a
benefit in survival or in reduced hospital stays, according to a large
multicenter study by pediatric researchers. This finding stands in contrast
to previous studies in hospitalized adults, for whom corticosteroids
dramatically reduced mortality.
"Because of the demonstrated benefits of these drugs in adults,
physicians have increasingly been using corticosteroids in children with
bacterial meningitis," said study leader Samir S. Shah, M.D., an infectious
diseases specialist from The Children's Hospital of Philadelphia. "This
study reminds us again that children are not just small adults. We need to
consider whether the problems associated with corticosteroid use, such as
gastrointestinal bleeding, outweigh any potential benefits."
He added that further research should analyze whether corticosteroids
may provide other benefits to children, such as improved neurological
outcomes among survivors, a question not considered in this study.
The study appears in the May 7 issue of the Journal of the American
Medical Association.
Shah's team analyzed medical records of 2,780 children with bacterial
meningitis at 27 U.S. pediatric hospitals from 2001 to 2006. The median age
of the children was nine months. Approximately 9 percent, or 248, of the
children studied received corticosteroids, with steroid use doubling during
the study period, from under 6 percent of children in 2001 to 12 percent in
2006.
There was no significant difference in mortality nor in time to
hospital discharge, between children who received corticosteroids and those
who did not. Overall, unadjusted mortality rates were 6 percent among
children receiving corticosteroids, versus 4 percent among those not
receiving them. There also was no significant difference in those outcomes
between those receiving and not receiving corticosteroids in the subsets of
children with meningitis caused by pneumococcal bacteria or by
meningococcal bacteria.
Meningitis is an inflammation of the meninges, the membrane lining the
brain. The bacterial form is relatively rare in children, with an incidence
of about eight in 100,000 in the U.S. However, bacterial meningitis is
potentially life-threatening, and requires hospitalization and treatment
with antibiotics. Several different varieties of bacteria may cause
meningitis, although the patterns have changed with the introduction of
vaccines.
Previous studies had shown that corticosteroids had a clear benefit in
preventing hearing loss in children whose meningitis was caused by
Hemophilus influenzae type b (Hib) bacteria. However, since the Hib vaccine
was approved for routine use in childhood immunizations in 1985, cases of
Hib meningitis have dropped sharply in the United States. Now bacterial
meningitis in children is more commonly caused by pneumococcal or
meningococcal bacteria.
Further studies may reveal that corticosteroids may also reduce hearing
loss or other neurologic injuries in children with bacterial meningitis not
caused by Hib, said Shah, but there is currently no such evidence. He
added, "Our study shows the need for a further study in children -- a large
randomized clinical trial to examine all outcomes of steroid use, before
the use of these medicines becomes routine in children with bacterial
meningitis."
The National Center for Research Resources, part of the National
Institutes of Health, supported the study, along with the Agency for
Healthcare Research and Quality. One co-author, Jillian Mongelluzzo,
received support from the Doris Duke Medical Student Clinical Research
Fellowship. Shah's other co-authors were Zeinab Mohamad, M.S., from
Children's Hospital, and Thomas R. Ten Have, Ph.D., from the University of
Pennsylvania School of Medicine.
About The Children's Hospital of Philadelphia: The Children's Hospital
of Philadelphia was founded in 1855 as the nation's first pediatric
hospital. Through its long-standing commitment to providing exceptional
patient care, training new generations of pediatric healthcare
professionals and pioneering major research initiatives, Children's
Hospital has fostered many discoveries that have benefited children
worldwide. Its pediatric research program is among the largest in the
country, ranking third in National Institutes of Health funding. In
addition, its unique family-centered care and public service programs have
brought the 430-bed hospital recognition as a leading advocate for children
and adolescents. For more information, visit http://www.chop.edu.
Contact: Rachel Salis-Silverman
Phone: (267) 426-6063
Salis@email.chop.edu
SOURCE The Children's Hospital of Philadelphia
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Related links:
http://www.chop.edu
CONTACT:
Rachel Salis-Silverman of The Children's
Hospital of Philadelphia, +1-267-426-6063, Salis@email.chop.edu
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