Pediatric neurology · 2026
Acute Necrotizing Encephalopathy in Children: Meta-Analysis of Observational Studies on the Efficacy of Steroid Treatment.
СтатьяМетаанализСистематический обзорНазвание и аннотация: Перевод в очереди
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Joffe Ari R, Khaira Gurpreet
Аннотация
BACKGROUND: To determine efficacy of early steroid therapy on outcomes in children with acute necrotizing encephalopathy.
METHODS: We leveraged two 2023 systematic reviews to identify eligible publications, predefined as having ≥3 patients, objective study outcomes categorized as good or poor, and described according to steroid therapy. Data were combined by (i) adding raw data from included studies (as done in the previous systematic review) and (ii) random effects meta-analysis with relative risk (RR) and 95% confidence interval (CI). Sensitivity analysis used a more consistent definition of good outcome and excluded lower quality studies. P values ≤0.05 and ≤ 0.005 were considered statistically suggestive or significant.
RESULTS: Nine retrospective observational studies were included, each with different definitions of good versus poor outcome. Combined numbers found a statistically suggestive effect for early steroids (RR 2.17 [95% CI 1.25, 3.76]; P = 0.006) and in the sensitivity analysis (RR 2.09 [95% CI 1.16, 3.93] P = 0.021) but not in subgroups with/without brainstem lesions. Meta-analysis found statistically suggestive effect for early steroids (RR 2.06 [95% CI 1.03, 4.09] P = 0.040); this was not statistically suggestive in sensitivity analysis (RR 2.03 [95% CI 0.99, 4.16] P = 0.052), in those without brainstem lesions, or for any steroids.
CONCLUSIONS: Meta-analysis suggested that it may be premature to assert that early steroids, even in those without brainstem involvement, will improve neurologic outcomes in children with acute necrotizing encephalopathy. For a false positive rate 5%, the required prior probability of effect would be implausibly high. Good outcomes were not uncommon, questioning the label 'necrotizing' in all cases.
METHODS: We leveraged two 2023 systematic reviews to identify eligible publications, predefined as having ≥3 patients, objective study outcomes categorized as good or poor, and described according to steroid therapy. Data were combined by (i) adding raw data from included studies (as done in the previous systematic review) and (ii) random effects meta-analysis with relative risk (RR) and 95% confidence interval (CI). Sensitivity analysis used a more consistent definition of good outcome and excluded lower quality studies. P values ≤0.05 and ≤ 0.005 were considered statistically suggestive or significant.
RESULTS: Nine retrospective observational studies were included, each with different definitions of good versus poor outcome. Combined numbers found a statistically suggestive effect for early steroids (RR 2.17 [95% CI 1.25, 3.76]; P = 0.006) and in the sensitivity analysis (RR 2.09 [95% CI 1.16, 3.93] P = 0.021) but not in subgroups with/without brainstem lesions. Meta-analysis found statistically suggestive effect for early steroids (RR 2.06 [95% CI 1.03, 4.09] P = 0.040); this was not statistically suggestive in sensitivity analysis (RR 2.03 [95% CI 0.99, 4.16] P = 0.052), in those without brainstem lesions, or for any steroids.
CONCLUSIONS: Meta-analysis suggested that it may be premature to assert that early steroids, even in those without brainstem involvement, will improve neurologic outcomes in children with acute necrotizing encephalopathy. For a false positive rate 5%, the required prior probability of effect would be implausibly high. Good outcomes were not uncommon, questioning the label 'necrotizing' in all cases.