Can infants be given steroids?

Steroid Use in Infants: Indications and Risks

Inhaled corticosteroids may be used in infants with established chronic lung disease, but systemic steroids should be avoided due to serious adverse neurological outcomes. 1

Types of Steroid Administration in Infants

Systemic Corticosteroids

• Not recommended for routine use in infants due to significant adverse effects:

  • Neurological complications: cerebral palsy, developmental delay, abnormal neurological examinations 1, 2
  • Growth impairment: decreased height and head circumference 2
  • Cardiovascular issues: hypertension, cardiomyopathy, interventricular septal hypertrophy 1
  • Metabolic effects: hyperglycemia 3
  • Decreased alveolar number in developing lungs 1

• The National Institute of Child Health and Human Development explicitly discourages routine use of oral corticosteroids in infants due to side effects and lack of long-term benefit 1

Inhaled Corticosteroids

• Preferred route when steroids are necessary for infants with chronic lung disease of infancy (CLDI) 1

• Benefits include:

  • Reduced symptoms and improved lung function in infants with CLDI 1
  • Decreased need for bronchodilator therapy 1
  • Fewer systemic side effects compared to oral administration 1

• Administration methods:

  • Metered-dose inhaler (MDI) with spacer is preferred over nebulization 1
  • Face mask helps ensure optimal drug delivery 1

Clinical Decision Algorithm for Steroid Use in Infants

When to Consider Inhaled Corticosteroids:

1. Established chronic lung disease of infancy (CLDI) with asthma-like symptoms 1
2. Ventilator-dependent infants after 3 weeks of life to facilitate extubation 4
3. Symptomatic premature infants at follow-up with CLDI 1

When to Avoid Steroids:

1. First 4 days of life - should not be used 4
2. First 3 weeks of life - not indicated 4
3. Extubated infants on nasal ventilation or oxygen therapy 4
4. Mild to moderate bronchiolitis - no benefit shown 5

Monitoring and Risk Mitigation

For Inhaled Corticosteroids:

• Monitor for potential side effects:

  • Delayed growth
  • Increased blood pressure
  • Osteoporosis
  • Adrenal suppression
  • Cataracts 1

• Prevent oral candidiasis by:

  • Rinsing the child's mouth after inhaled corticosteroid use
  • Timing inhaled corticosteroid use just before tooth brushing 1, 6

For Antenatal Corticosteroids:

• A single course of antenatal betamethasone has clear benefits for preterm birth risk 3
• However, repeated courses may be harmful and should be avoided 3
• For infants born at term after antenatal corticosteroid exposure:
  • Increased odds of lower growth percentile
  • No increased risk of asthma, developmental delay, or attention deficit disorders 7

Common Pitfalls to Avoid

1. Using systemic steroids as first-line therapy - The risks far outweigh benefits in most cases
2. Prolonged steroid courses - Use the lowest effective dose for the shortest possible duration 4
3. Ignoring alternative therapies - Consider other treatment options before resorting to steroids
4. Failure to monitor for side effects - Regular assessment of growth, blood pressure, and development is essential
5. Overlooking the importance of delivery method - MDI with spacer is preferred over nebulization 1

In conclusion, while steroids can be beneficial in specific clinical scenarios for infants, their use must be carefully considered against the significant risks, particularly for systemic administration. Inhaled corticosteroids represent a safer alternative when steroid therapy is deemed necessary.