Effect of corticosteroids on survival of children with acquired immunodeficiency syndrome and Pneumocystis carinii -related respiratory failure

Outcome of HIV-positive children with Pneumocystis carinii pneumonia requiring intensive care

“…Data on viral loads or CD4 counts were not available as many of these infants died before formal assessment was possible having presented unexpectedly in respiratory failure. 4 Although, we cannot be certain which infants were more immunocompromised our poor survival results for those who needed intensive care are in keeping with data from other centers. 2 Despite the rapid improvement in provision of paediatric intensive care there has been a disappointing lack of improvement in duration of survival within the last 2 years compared to the previous 5 years.…”

“…4 Abstract Extreme measures and vital resources are employed in trying to prevent children with acute lung injury secondary to Pneumocystis carinii pneumonia (PCP) from dying. However, the outcome of infants and children who present with PCP requiring intensive care management including mechanical ventilation is not clear from the literature.…”

Guidelines for the Prevention and Treatment of Opportunistic Infections in HIV-Exposed and HIV-Infected Children

“…Pediatric studies have indicated reduced acute respiratory failure, decreased need for ventilation, and decreased mortality with early use of corticosteroids in HIV-infected children who have PCP. 80–82 Indications for corticosteroid treatment include a PaO 2 value of <70 mm Hg or an alveolar-arterial gradient of >35 mm Hg. Doses for children vary between studies.…”

Pneumocystis carinii pneumonia as a presenting feature of X‐linked hyper‐IgM syndrome

“…Although no controlled clinical trials have been conducted for children, several investigators reported improved survival rates for children with PCP who received steroids in addition to antimicrobial treatment. In a retrospective chart review, McLaughlin et al 10 . reported a significant improvement in survival, from a historical rate of 11−91% when the routine use of steroids was adopted in the treatment of PCP.…”