Pediatr Int

. 2023 Jan-Dec;65(1):e15603.
doi: 10.1111/ped.15603. Methylprednisolone use in children with severe pneumonia caused by severe acute respiratory syndrome coronavirus 2

Yasemin Ozsurekci 1 , Kubra Aykac 1 , Osman Oguz Demir 2 , Sare Ilbay 1 , Selman Kesici 3 , Jale Karakaya 4 , Ali Bulent Cengiz 1


Background: This study aimed to evaluate the effectiveness and optimal use of corticosteroids in children with severe coronavirus disease 2019 (COVID-19) pneumonia, for which effective treatment is still lacking with respect to this population.
Methods: We conducted a retrospective study and included patients (aged < 18 years) with severe COVID-19 pneumonia and/or acute respiratory distress syndrome (ARDS) who received standard doses (2-4 mg/kg/day) and high doses (>250 mg/day) of methylprednisolone (MPZ). We adjusted for patients on steroid treatments with a propensity score and compared the side effects of different MPZ doses and patient survival.
Results: Fifty-nine patients were included: 61% were male, the median age was 8, interquartile range (IQR) 2-15) years. The overall survival was 84.4% in patients treated with standard-dose MPZ (n = 45, 76.3%) and 92.2% in patients treated with high-dose MPZ (n = 14, 23.7%; p = 0.67). The demographic, clinical, and laboratory data did not differ significantly after propensity score matching, apart from bradycardia, which was a prominent feature of the high-dose group. The clinical and radiological response rates on day 7 were higher and the need for invasive mechanical ventilation (IMV) was lower in the high-dose group.
Conclusion: The patients with high-dose MPZ had better clinical and radiological responses than those with standard-dose MPZ, although the mortality rate did not differ between standard and high-dose regimens of MPZ.

Keywords: acute respiratory distress syndrome (ARDS); childhood; coronavirus disease 2019 (COVID-19); corticosteroid; interleukin-1 receptor antagonist.