Endocrine Abstracts

Introduction: Adverse drug reactions (ADRs) are a significant cause of morbidity in childhood. We undertook a prospective study to investigate ADRs causing admission to a UK paediatric hospital: this report focuses on corticosteroids (CS).

Methods: Three investigators assessed all acute admissions over a 1 year period and identified ADRs by cross-referencing clinical presentations to known ADR profiles using a standardised causality tool.

Results: Of 240/8345 (2.9%) acute admissions had an ADR. CS contributed to causality in 102/240 (42.5%) ADR admissions. 57/102 (55.9%) were oncology admissions with febrile neutropenia who had received CS alongside chemotherapy. 45/102 (44.1%) of the CS-related ADR admissions occurred in paediatric non-oncology patients. 23/45 (51.1%) of these occurred in children re-admitted with post-operative bleeding (22/23 post-tonsillectomy) after elective surgical procedures, the majority of whom had received intra-operative CS and pre/post-operative NSAIDs. Children receiving Immunosuppression (IS) that included CS with culture-positive bacterial infections or known adverse events such as shingles, accounted for 17/45 (37.8%) of these non-oncology ADR admissions. In addition, two children (4.4%) were admitted with hyperglycaemia, one (2.2%) with hypertension and one with impaired healing of a surgical wound. One child was admitted with adrenal suppression following long-term administration of intra-nasal steroids.

Conclusion: Children receiving CS contributed almost half of the ADR admissions to a UK paediatric hospital. Some of the CS ADRs observed in this study were serious and caused by steroids. In other cases, CS were concomitant medication and the contribution of CS to ADRs among oncology, IS and tonsillectomy patients should be assessed. Strategies to reduce the burden of ADRs attributable to CS in children should be developed.