The impact of corticosteroid therapy on clinical outcomes in paediatric deep neck space infections: A meta-analysis.

INTRODUCTION: Deep neck space infections (DNSIs), including retropharyngeal and parapharyngeal abscesses, pose significant clinical challenges in the paediatric population. Importantly, they may be associated with risks such as airway obstruction, mediastinitis, internal jugular vein thrombosis, and sepsis. Recent trends indicate a rising incidence of DNSIs, potentially linked to increasing antibiotic-resistance. Surgical intervention is usually required when medical management fails. The role of corticosteroid use in these patients is unclear. METHODS: Following PRISMA guidelines, a systematic review of four electronic databases from January 1996 to August 2024 was performed. The review focused on original studies concerning the paediatric population and the use of corticosteroids in the management of DNSIs. The primary outcome evaluated was rate of surgical intervention. A random effects meta-analysis was performed to estimate the effect of corticosteroids on the probability of surgery. RESULTS: Three studies comprising a total of 2523 patients met the inclusion criteria. Corticosteroids were used with antibiotics in 695 patients, whereas antibiotics were used without corticosteroids in 1828 patients (control group). The implementation of surgical intervention for DNSIs was found to be significantly higher when corticosteroids were not administered, with a relative risk (RR) of 2.07 (95% CI: 1.43 - 2.99). Moderate heterogeneity was observed between studies (I2 = 58.8%, p = 0.088). CONCLUSION: Corticosteroids usage was associated with a reduced need for surgical intervention in paediatric DNSIs. Further research is needed to establish definitive treatment protocols and to determine short and long-term side effects.