The effect of high dose dexamethasone in children with severe closed head injury - A preliminary report

Out of a total of 157 hospitalized head-injured children, twelve years of age and under, fifteen were considered to be severe, three of whom died within 72 hours of admission. Nine children with closed head injuries who were in coma for at least 24 hours (did not open eyes, speak, or follow commands), with absent or impaired oculocephalic reflex, impaired pupil reactivity to light, and who were decerebrating for at least twelve hours, were studied. Five were given high dose dexamethasone therapy (1 mg/kg) within six hours of injury, repeated at six hours, and then maintained at 1 mg/kg/day for eight days, and four either received none or were treated with a low dose regimen (0.25 mg/kg/day). In those receiving high dose therapy, intracranial pressure waves were noticeably less, peak intracranial pressure was lower, and intensive care and hospital stay were shorter. It was also noted that in the high dose therapy group spontaneous eye opening and speech returned sooner, and all were considered to have returned to their premorbid status by six months following injury. Of the no steroid or low dose group, one died, and of the remainder at six months one was aphasic and still decerebrating, another was aphasic and severely handicapped, and the third returned to school seven months after injury.