Aims Determine incidence, clinical significance and management of steroid induced bardycardia in children undergoing cancer chemotherapy
Methodology Retrospective, observational, case note review of children treated at a tertiary paediatric oncology centre between 1st January 2013 and 1st September 2014 (21 months). Patients were subdivided into four groups based on steroid type, dose and indication.
High dose dexamethasone (10 mg/m2/day)
Standard dose dexamethasone (6 mg/m2/day)
Non-Hodgkin Lymphoma prednisolone (60 mg/m2/day)
Other (variable dosing)
Simultaneous data collected on age, baseline heart rate (HR) at presentation, lowest HR on steroids, blood pressure (BP), ECG and intra-ocular pressure (IOP).
Statistics: P values calculated
Bradycardia of ≥30% was considered significant as it correlated with a Paediatric Early Warning Score (PEWS) of 2.
Results Total of 136 patients were diagnosed, 6 notes were not located. 60/130 had steroid treatment. 47/60 (78.3%) experienced significant bradycardia (Table 1).
There was no statistically significant difference in the degree of bradycardia between the different dosages and types of steroids used.
Infants were not at a significantly higher risk for bradycardia (n = 3).
ECG on 11/47 patients showed either no change or sinus bradycardia. IOP was raised in 2/3 measured patients.
Conclusions This is the first clinical study reviewing the clinical relevance of steroid induced bradycardia in paediatric cancer.
Majority of patients on steroid treatment for cancer showed significant bradycardia with no clinical decompensation. No risk factors were identified with respect to dose, type of steroid or age group.
We recommend correlation with BP, ECG, probably IOP measurement in the monitoring of patients on steroid treatment for cancer chemotherapy. Appropriate PEWS charting and escalation of management should still be followed.
This is also the first study to document clinically relevant steroid induced glaucoma in paediatric malignancy treatment. This has led to a further collaborative study to investigate the interaction/mechanism of steroid induced glaucoma and bradycardia in paediatric malignancy.
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