Dexamethasone Use in Pediatric Neurosurgical Trauma: A Systematic Review and Proportional Meta-Analysis of the Current Literature

Study Design: Systematic Review with Proportional Meta-Analysis Objectives: Dexamethasone use in pediatric neurosurgical trauma remains controversial, with varying reports of its overall efficacy. Our study aims to assess the use of dexamethasone in pediatric neurosurgery regarding patient characteristics, risk factors, and dosing. Methods: A systematic review was conducted using PubMed according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines to identify literature presenting dexamethasone use in pediatric neurosurgical trauma. Results: A total of 597 publications were identified, of which 13 met inclusion criteria (2 case reports, 11 retrospective studies). Case reports (N=4 patients, mean age 13.5 years) demonstrated traumatic brain injury with cerebral edema, hematoma, or swelling. All patients received dexamethasone (5–7 days), experienced no treatment-related complications, and 75% showed neurological improvement. Across 11 retrospective studies (N=493 patients, mean age 7.3 years), most presented with severe TBI and cerebral edema. Management strategies included conservative therapy (83%) or surgical intervention (13%). Dexamethasone was used in 61% of patients (average 0.92 mg/kg/day for 4.7 days). Reported outcomes were mixed: some studies demonstrated reduced mortality, improved neurological recovery, and lower ICP with dexamethasone, while others reported increased infection risk, catabolic effects, and no significant benefit. Pooled subgroup analysis showed patients who improved neurologically were more likely to have received dexamethasone (80.6% vs. 58.7%, p = 0.0347), whereas those who declined were less likely to have received it (19.4% vs. 41.3%, p = 0.0347). Infection was more common in dexamethasone-treated patients (52.0% vs. 16.7%, p = 0.0049). Conclusion: Evidence regarding dexamethasone use in pediatric traumatic brain injury is conflicting. Although some older studies suggest benefits including reduced ICP and mortality, most studies report limited efficacy and increased complications such as hyperglycemia, hypertension, gastrointestinal bleeding, and infections. Given the small number of available studies, no definitive recommendation can be made at this time. Further high-quality research is needed to clarify its role and establish guidelines for use in pediatric neurosurgical trauma.