The effect of early use of glucocorticoids on the prognosis of pediatric patients with severe pneumonia complicated with respiratory failure

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Objective To preliminarily discuss about the effect of early use of glucocorticoids on the prognosis of pediatric patients with respiratory failure by severe pneumonia. Methods The patients enrolled in our study were treated for respiratory failure by severe pneumonia in PICU of Tianjin Children′s Hospital from January 2011 to December 2014.These patients were divided into two groups: glucocorticoid treatment group and non-glucocorticoid treatment group.The patients in the glucocorticoid treatment group were treated with glucocorticoid in 3 days of onset.Based on this main division, retrospective analyses were performed with regard to the prognosis: survival or death.Survival patients would be further divided into cure group and post-infectious bronchiolitis obliterans group.We analyzed the data with χ2-test about the effect of early use of glucocorticoids on the prognosis of pediatric patients with respiratory failure by severe pneumonia. Results Two hundred and sixteen patients were divided into glucocorticoid treatment group(n=68) and non-glucocorticoid treatment group(n=148). Significant difference was not found in age, gender, pediatric critical illness score and complications between the glucocorticoid treatment group and non-glucocorticoid treatment group.Although the mortality rate of glucocorticoid treatment group(22.06%) was slightly lower than that of non-glucocorticoid treatment group(27.70%), there was no statistical difference between the two groups(χ2=0.773, P>0.05). For the 160 survival patients, the occurrence rate of post-infectious bronchiolitis obliterans in the glucocorticoid treatment group increased compared with that in the non-glucocorticoid treatment group[28.3%(15/53)vs.2.8%(3/107); χ2=23.080, P<0.005]. Conclusion The early use of glucocorticoids cannot reduce the mortality of the pediatric patients with respiratory failure by severe pneumonia, but it can increase the risk of post-infectious bronchiolitis obliterans for survival patients.Therefore, glucocorticoids should be used with caution in the early treatment of severe pneumonia. Key words: Glucocorticoids; Severe pneumonia; Post infectious bronchiolitis obliterans