A 10 Year Retrospective Observational Study on The Utility and
Prescription Standards of Dexamethasone in Pediatric Neuro-oncosurgery
in a Tertiary Care Centre.
Object: This study aimed to retrospectively assess dexamethasone utility
in pediatric CNS tumor patients over a 10-year period, to better
understand dosing variability, and highlight optimal practice. Methods:
All pediatric CNS tumor cases managed operatively for a ten year period
at a single center were reviewed. Information was gathered on
demographics, dexamethasone doses, course durations, weaning regimes,
PPI co-prescription, adverse events, and route of administration.
Comparison within these groups was analyzed through use of statistical
testing. Results: 127 patients received 193 dexamethasone courses.
Median age was 7 years, with a median weight of 27.9kg. Most common
tumor type was astrocytoma (24.8%). Median daily dose was 8mg, with
twice daily dosing most common. Median course duration was 8 days,.
Median weaning duration was 11.5 days. Daily dose was not correlated
with patient weight and the median daily dose per kg was 0.2319mg/kg.
Dexamethasone dose per kg was significantly inversely correlated with
age. 44.9% of patients received intravenous dexamethasone only. 32.7%
received oral dexamethasone only. 22.4% received multiple different
routes of administration throughout their course. Intravenous
dexamethasone was more commonly used in young age groups. Incidence of
adverse effects was 14.5% with Cushing’s syndrome most common.
Dexamethasone dose per kg was not significantly different between
patients with and without adverse effects; however, average
dexamethasone course duration was significantly different between these
groups. No relationship was noted between adverse effects incidence and
administration route. 64.2% of patients received concurrent PPI with
35.8% receiving no PPI. Conclusions: Large variation was seen in
practice, with prescriptions appearing based on clinician preference and
symptom severity rather than patient age or weight. Dexamethasone
administration route interestingly showed no relationship with incidence
of adverse effects. Future guidelines should consider lower dose
regimens with less frequent dosing as these may benefit quality of life.