Dexamethasone oral (Decadron, DexPak) is a drug prescribed to reduce inflammation in many conditions, including:
For our hospital, half our children who present and are clearly treated for asthma exacerbations in our ED are younger than 5 years old. I agree that steroids have no evidence in bronchiolitis in younger children. However, the most recently published metaanalysis of children in this age range with repeated wheezing episodes receiving steroids suggests steroids given in the ED reduce risk of hospitalization. (Castro-Rodriguez JA et al. Efficacy of oral corticosteroids in the treatment of acute wheezing episodes in asthmatic preschoolers: Systematic review with meta-analysis. Pediatr Pulmonol. 2016;(November 2015)). In light of this, I wouldn’t consider the Keeney metaanalysis weakened. I’d be glad to hear your view on the evidence.
A wide range of psychiatric reactions including affective disorders (such as irritable, euphoric, depressed and labile mood and suicidal thoughts), psychotic reactions (including mania, delusions, hallucinations and aggravation of schizophrenia), behavioural disturbances, irritability, anxiety, sleep disturbances and cognitive dysfunction including confusion and amnesia have been reported. Reactions are common and may occur in both adults and children. In adults, the frequency of severe reactions has been estimated to be 5-6%. Psychological effects have been reported on withdrawal of corticosteroids; the frequency is unknown.