What are the expected side effects of prednisone (corticosteroid) in infants?

Side Effects of Prednisone in Infants

Prednisone administration in infants is associated with significant adverse effects including growth suppression, increased risk of infection, and cosmetic changes, and should be used at the lowest effective dose for the shortest duration possible only when benefits clearly outweigh risks.

Common Side Effects in Infants

Short-term Side Effects (Days to Weeks)

• Increased risk of infection:

  • 2.19-fold increased risk of pneumonia within 5-30 days after starting therapy 1
  • 2.02-fold increased risk of sepsis within first month 1
  • Suppressed immune function 2

• Gastrointestinal effects:

  • 1.41-fold increased risk of GI bleeding within first month 1
  • Irritability and discomfort 2

• Metabolic and endocrine effects:

  • Hyperglycemia 2
  • Fluid retention 2
  • Hypertension 2

• Neuropsychiatric effects:

  • Irritability 2
  • Sleep disturbances 2
  • Mood changes 2

Long-term Side Effects (Weeks to Months)

• Growth suppression:

  • Decreased growth velocity even at low doses 2
  • Growth suppression may occur without laboratory evidence of HPA axis suppression 2
  • Growth velocity is a more sensitive indicator of corticosteroid exposure in infants than standard HPA axis function tests 2

• Adrenal suppression:

  • Risk of secondary adrenocortical insufficiency 2
  • May persist for up to 12 months after discontinuation of therapy 2
  • Infants born to mothers who received substantial doses during pregnancy should be monitored for signs of hypoadrenalism 2

• Bone development:

  • Decreased bone formation 2
  • Increased bone resorption 2
  • Inhibition of bone growth 2

• Cosmetic changes (with prolonged use):

  • Facial rounding (cushingoid appearance) 3
  • Weight gain 3

Special Considerations for Infants

1. Growth monitoring:

   • Monitor linear growth carefully during treatment 2
   • Growth suppression can occur even with short courses 4
   • Dexamethasone and betamethasone have approximately 18 times higher potency in suppressing growth compared to prednisolone 4

2. Dosing considerations:

   • Use the lowest possible effective dose 2
   • Titrate to the lowest effective dose to minimize growth effects 2
   • When possible, consider alternate-day therapy to minimize growth suppression 4

3. Duration of therapy:

   • Limit duration of therapy whenever possible 2
   • Gradual tapering is necessary to prevent adrenal insufficiency 2

4. Route of administration:

   • Consider inhaled corticosteroids when appropriate for respiratory conditions 5
   • Inhaled corticosteroids via metered-dose inhaler with spacer have fewer systemic side effects than oral administration 5

Risk Mitigation Strategies

1. Before initiating therapy:

   • Carefully weigh benefits against risks 2
   • Consider alternative therapies when possible 5
   • Explain potential side effects to parents/caregivers 3

2. During therapy:

   • Monitor weight, height, blood pressure regularly 2
   • Assess for signs of infection 2
   • Watch for behavioral changes 2

3. After therapy:

   • Taper dose gradually to prevent adrenal insufficiency 2
   • Continue monitoring growth and development 2
   • Be aware that adrenal suppression may persist for up to 12 months 2

Clinical Pitfalls to Avoid

1. Avoid abrupt discontinuation of prednisone as this may precipitate adrenal crisis 2

2. Do not use systemic corticosteroids routinely in infants with respiratory conditions when alternatives exist 5

3. Do not overlook the need for stress-dose steroids during illness or surgery in infants who have received prolonged courses of prednisone 2

4. Avoid unnecessary or prolonged courses of prednisone in infants, as even short "burst" therapy carries risks 1

5. Do not use dexamethasone or betamethasone when prednisone would suffice, as they have much higher growth-suppressive effects 4