251 General discussion 8 Measurements Main findings - - Quality of evidence was very low. - Younger patients seem at risk for behavior problems. - Older patients may be at risk for sleep problems. - Type/dose of steroid may be related to sleep problems. - No studies describing parental stress or medical history were identified. - Limited studies on genetic susceptibility which remain to be replicated. - - Prospective Identification study: designed to select patients for the RCT and to identify risk factors for steroid-induced neurobehavioral and sleep problems. - Double-blind placebo-controlled RCT with a cross-over design: designed to compare hydrocortisone with placebo as intervention for dexamethasone-induced problems. Outcomes - Behavior: SDQ questionnaire - Sleep: SDSC questionnaire Determinants - Patient/parent demographics - Treatment characteristics - Parenting stress: NOSI-K - Parental stress: DT-P - Dexamethasone pharmacokinetics - Genetic variation: candidate SNP - Parents reported clinically relevant neurobehavioral side effects in 70 (67%) and sleep problems in 61 (59%) patients. - Parenting stress was a significant determinant for neurobehavioral and sleep problems in their children. - Parents who experienced more stress before start of a dexamethasone course reported more sleep problems in their child. - Dexamethasone pharmacokinetics, genetic variation, patient/parent demographics, or disease/treatment characteristics were not associated with the outcomes. - Leptin SDS - Fat mass (bioelectrical impedance analysis) - BMI - Hunger: four VAS scores - Fatigue: PedsQL-MFS questionnaire - Sleep: SDSC questionnaire - Leptin and fat mass, as well as hunger scores, fatigue and sleep deteriorated significantly after five days of dexamethasone (p<0.001) - No significant correlations between delta leptin and delta hunger, fatigue, sleep or BMI were found. - This suggests a dexamethasone-induced state of acute leptin resistance. - Elevated leptin SDS was associated with older age, higher fat mass and earlier maintenance week.
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