189 Hydrocortisone as an intervention (RCT) 6 Dexamethasone only RCT Course 1 RCT Course 2 RCT Course 3 RCT Course 4 0 10 20 Delta SDQ Total Difficulties score Hydrocortisone Placebo Total Group Randomization Cross-over Dexamethasone only RCT Course 1 RCT Course 3 0 5 10 15 20 Delta SDSC Total Score Randomization Cross-over Dexamethasone only RCT Course 1 RCT Course 3 0 1 2 3 4 5 Delta Worst Hunger Score Randomization Cross-over RCT Course 1 RCT Course 3 -30 -20 -10 0 Delta PedsQL Total Score Cross-over Dexamethasone only RCT Course 1 RCT Course 3 0 1 2 3 4 5 Delta Thermometer Score Randomization Cross-over A B C D SDSC Eating Thermometer PedsQL Distress Thermometer Figure 4. Effect of hydrocortisone and placebo on (dexamethasone-induced) sleep problems, feeling hungry, quality of life and parental distress The total group (n = 51) during a ‘dexamethasone only’ course is indicated with a grey triangle. After randomization patients who receive hydrocortisone are indicated with an orange circle, and patients who receive placebo are indicated with a blue square (n = 26 or n = 25). (A) Delta SDSC Total score (median with IQR). (B) Delta Worst Hunger score (median with IQR). (C) Delta PedsQL total score (median with IQR). The PedsQL was only measured during the RCT. (D) Delta Thermometer score: Parental distress measured with the Distress thermometer for parents (median with IQR). Abbreviations: IQR: interquartile range, SDSC: sleep disturbance scale for children, PedsQL: pediatric quality of life (questionnaire), RCT: randomized clinical trial.
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