Is oral dexamethasone (corticosteroid) safe for infants?

From the Guidelines

Oral dexamethasone should be used with caution in infants, as high doses (approximately 0.5 mg/kg per day) have been associated with numerous short- and long-term adverse outcomes, including neurodevelopmental impairment. The medication is sometimes prescribed for specific conditions like croup, severe asthma, or certain inflammatory conditions, typically in short courses (often 1-5 days) at doses calculated based on the infant's weight (commonly 0.15-0.6 mg/kg/day) 1. However, corticosteroids like dexamethasone carry significant risks for infants, including potential effects on growth, immune system suppression, and metabolic disturbances. Short-term side effects may include irritability, increased appetite, and sleep disturbances. Long-term or repeated use poses greater concerns for developmental impacts.

Key Considerations

• Low-dose dexamethasone therapy (less than 0.2 mg/kg per day) may facilitate extubation and decrease the incidence of short- and long-term adverse effects observed with higher doses of dexamethasone 1.
• Parents should never administer dexamethasone to infants without explicit medical direction, should follow dosing instructions precisely, complete the prescribed course, monitor for side effects, and inform all healthcare providers about the medication use.
• The risk-benefit assessment is crucial because while dexamethasone can effectively reduce inflammation and manage certain acute conditions, its potent systemic effects require careful consideration in developing infants whose organ systems are still maturing 1.

Safety and Efficacy

• High-dose dexamethasone (0.5 mg/kg per day) does not seem to confer additional therapeutic benefit over lower doses and is not recommended 1.
• Evidence is insufficient to make a recommendation regarding other glucocorticoid doses and preparations, emphasizing the need for clinical judgment when balancing potential adverse effects of glucocorticoid treatment with those of bronchopulmonary dysplasia 1.
• Inhaled corticosteroids are preferred for preventing side effects of systemic corticosteroids, and infants treated with inhaled corticosteroids should be monitored for potential steroid side effects, including delayed growth, increased blood pressure, osteoporosis, adrenal suppression, and cataracts 1.

From the FDA Drug Label

Growth and development of infants and children on prolonged corticosteroid therapy should be carefully followed. The use of oral dexamethasone in infants requires careful consideration, as prolonged corticosteroid therapy may affect their growth and development.

• Key points to consider:
  • Monitoring: Infants on oral dexamethasone should be closely monitored for any signs of adverse effects.
  • Dose and duration: The lowest possible dose and shortest duration of therapy should be used to minimize potential risks.
  • Potential risks: Oral dexamethasone may suppress growth, interfere with endogenous corticosteroid production, or cause other unwanted effects in infants. It is essential to weigh the potential benefits of oral dexamethasone against the possible hazards to the infant 2.

From the Research

Safety of Oral Dexamethasone in Infants

• The safety of oral dexamethasone in infants can be evaluated based on its use in various pediatric conditions, including asthma exacerbations and croup 3, 4, 5.
• A study published in 2009 found that a short course of oral dexamethasone (0.3 to 0.6 mg/kg daily for 1 to 5 days) was effective in reducing hospital admissions and unscheduled return to care in pediatric patients with acute asthma exacerbations, with minimal side effects 4.
• Another study published in 2006 compared the efficacy of a single dose of oral dexamethasone (0.6 mg/kg) with 5 days of twice-daily prednisolone in children with mild to moderate asthma exacerbations, and found that the two treatments were equally effective 5.
• However, a study published in 2001 found that intravenous dexamethasone administration prior to extubation in newborn infants reduced the need for reintubation, but also noted potential side effects such as higher blood sugar levels and glycosuria 6.
• It is essential to note that the use of oral dexamethasone in infants should be guided by the specific clinical condition being treated, and the dosage and duration of treatment should be carefully considered to minimize potential side effects 3, 6, 4, 5.

Potential Side Effects

• The potential side effects of oral dexamethasone in infants include higher blood sugar levels and glycosuria, as noted in the study published in 2001 6.
• Other potential side effects of corticosteroids in general include growth retardation, adrenal suppression, and effects on bone metabolism, although these effects are generally associated with long-term use of high-dose corticosteroids 7.
• The studies reviewed did not report any significant side effects associated with the use of oral dexamethasone in infants, but emphasized the importance of careful consideration of the dosage and duration of treatment to minimize potential risks 3, 4, 5.