tetano
Editor, Senior Moderator
PLoS One
. 2026 Jun 18;21(6):e0350888.
doi: 10.1371/journal.pone.0350888. eCollection 2026.
Evaluation of steroids for acute COVID in the prevention of long COVID in children: An EHR and pediatric cohort study from the RECOVER Initiative
Kathryn Hirabayashi[SUP] 1 [/SUP], Vitaly Lorman[SUP] 1 [/SUP], Shannon Wuller[SUP] 2 [/SUP], Leyna V Aragon[SUP] 3 4 [/SUP], Ravi Jhaveri[SUP] 5 [/SUP], Nita Jain[SUP] 4 6 [/SUP], John Erik Leikauf[SUP] 7 [/SUP], Jennifer A Muszynski[SUP] 8 [/SUP], Aaron Thomas Martinez[SUP] 4 [/SUP], Miranda Higginbotham[SUP] 1 [/SUP], Payal B Patel[SUP] 9 [/SUP], Marc A Sala[SUP] 10 [/SUP], Grant S Schulert[SUP] 11 [/SUP], Mei Liu[SUP] 12 [/SUP], Stacey Knight[SUP] 13 [/SUP], Elizabeth A Chrischilles[SUP] 14 [/SUP], Yuriy Bisyuk[SUP] 15 [/SUP], Bradley W Taylor[SUP] 16 [/SUP], Abu Saleh Mohammad Mosa[SUP] 17 [/SUP], Sandy L Gonzalez[SUP] 18 [/SUP], Matthew Authement[SUP] 19 [/SUP], Wyatt P Bensken[SUP] 20 [/SUP], Daniel Fort[SUP] 21 [/SUP], Soledad A Fernandez[SUP] 22 [/SUP], Jonathan Arnold[SUP] 23 [/SUP], Michael J Becich[SUP] 24 [/SUP], Wenke Hwang[SUP] 25 [/SUP], Mollie R Cummins[SUP] 26 [/SUP], Susan Kim[SUP] 27 [/SUP], Yacob G Tedla[SUP] 28 [/SUP], L Charles Bailey[SUP] 1 [/SUP], Christopher B Forrest[SUP] 1 [/SUP], Suchitra Rao[SUP] 29 [/SUP]; RECOVER Consortium
Affiliations
Background: Studies have shown that use of immunomodulators during the acute phase of SARS-CoV-2 infection may decrease development of post-acute sequelae of SARS-CoV-2 (PASC) or long COVID; however, such studies have not been conducted in children.
Objective: Evaluate the effectiveness of steroid use during the acute phase of SARS-CoV-2 infection in preventing long COVID in children.
Methods: We conducted a retrospective cohort study using target trial emulation methodology to compare children and youth who did and did not receive dexamethasone, prednisone, prednisolone or methylprednisolone within 12 days of SARS-CoV-2 infection. Inverse propensity of treatment weighting was used to balance covariates between treated and untreated patients in hospitalized and outpatient groups. The primary outcome was the development of PASC in the 1-6 months following acute infection using a computable phenotype definition. Secondary outcomes included respiratory, musculoskeletal, gastrointestinal and neurological subphenotypes and the PASC ICD-10-CM diagnosis code. We calculated hazard ratios from Cox proportional models with 95% confidence intervals.
Results: From a starting cohort of 854,128 children/youth, of whom 768,845 (90.0%) were outpatients and 85,283 (10.0%) were inpatients at the time of SARS-CoV-2 infection, the weighted outpatient cohort included 22,085 steroid-treated children and 20,373 in the non-steroid group. Following weighting, the hospitalized cohort included 11,250 steroid-treated children and 10,340 untreated children. In hospitalized patients, there were no significant treatment differences in the development of PASC in the 1-6 months following acute SARS-CoV-2 infection except for a lower risk of gastrointestinal PASC in treated patients (HR: 0.58; [95% CI: 0.39-0.85], p = 0.01). In outpatients, no treatment differences were observed in the development of PASC subphenotypes.
Conclusions: Steroids administered during acute SARS-CoV-2 infection did not lead to a decreased risk of PASC, with the exception of gastrointestinal presentations. Additional studies are needed to confirm the benefit of steroids and other immunomodulators in preventing long COVID.
. 2026 Jun 18;21(6):e0350888.
doi: 10.1371/journal.pone.0350888. eCollection 2026.
Evaluation of steroids for acute COVID in the prevention of long COVID in children: An EHR and pediatric cohort study from the RECOVER Initiative
Kathryn Hirabayashi[SUP] 1 [/SUP], Vitaly Lorman[SUP] 1 [/SUP], Shannon Wuller[SUP] 2 [/SUP], Leyna V Aragon[SUP] 3 4 [/SUP], Ravi Jhaveri[SUP] 5 [/SUP], Nita Jain[SUP] 4 6 [/SUP], John Erik Leikauf[SUP] 7 [/SUP], Jennifer A Muszynski[SUP] 8 [/SUP], Aaron Thomas Martinez[SUP] 4 [/SUP], Miranda Higginbotham[SUP] 1 [/SUP], Payal B Patel[SUP] 9 [/SUP], Marc A Sala[SUP] 10 [/SUP], Grant S Schulert[SUP] 11 [/SUP], Mei Liu[SUP] 12 [/SUP], Stacey Knight[SUP] 13 [/SUP], Elizabeth A Chrischilles[SUP] 14 [/SUP], Yuriy Bisyuk[SUP] 15 [/SUP], Bradley W Taylor[SUP] 16 [/SUP], Abu Saleh Mohammad Mosa[SUP] 17 [/SUP], Sandy L Gonzalez[SUP] 18 [/SUP], Matthew Authement[SUP] 19 [/SUP], Wyatt P Bensken[SUP] 20 [/SUP], Daniel Fort[SUP] 21 [/SUP], Soledad A Fernandez[SUP] 22 [/SUP], Jonathan Arnold[SUP] 23 [/SUP], Michael J Becich[SUP] 24 [/SUP], Wenke Hwang[SUP] 25 [/SUP], Mollie R Cummins[SUP] 26 [/SUP], Susan Kim[SUP] 27 [/SUP], Yacob G Tedla[SUP] 28 [/SUP], L Charles Bailey[SUP] 1 [/SUP], Christopher B Forrest[SUP] 1 [/SUP], Suchitra Rao[SUP] 29 [/SUP]; RECOVER Consortium
Affiliations
- PMID: 42313767
- PMCID: PMC13278399
- DOI: 10.1371/journal.pone.0350888
Background: Studies have shown that use of immunomodulators during the acute phase of SARS-CoV-2 infection may decrease development of post-acute sequelae of SARS-CoV-2 (PASC) or long COVID; however, such studies have not been conducted in children.
Objective: Evaluate the effectiveness of steroid use during the acute phase of SARS-CoV-2 infection in preventing long COVID in children.
Methods: We conducted a retrospective cohort study using target trial emulation methodology to compare children and youth who did and did not receive dexamethasone, prednisone, prednisolone or methylprednisolone within 12 days of SARS-CoV-2 infection. Inverse propensity of treatment weighting was used to balance covariates between treated and untreated patients in hospitalized and outpatient groups. The primary outcome was the development of PASC in the 1-6 months following acute infection using a computable phenotype definition. Secondary outcomes included respiratory, musculoskeletal, gastrointestinal and neurological subphenotypes and the PASC ICD-10-CM diagnosis code. We calculated hazard ratios from Cox proportional models with 95% confidence intervals.
Results: From a starting cohort of 854,128 children/youth, of whom 768,845 (90.0%) were outpatients and 85,283 (10.0%) were inpatients at the time of SARS-CoV-2 infection, the weighted outpatient cohort included 22,085 steroid-treated children and 20,373 in the non-steroid group. Following weighting, the hospitalized cohort included 11,250 steroid-treated children and 10,340 untreated children. In hospitalized patients, there were no significant treatment differences in the development of PASC in the 1-6 months following acute SARS-CoV-2 infection except for a lower risk of gastrointestinal PASC in treated patients (HR: 0.58; [95% CI: 0.39-0.85], p = 0.01). In outpatients, no treatment differences were observed in the development of PASC subphenotypes.
Conclusions: Steroids administered during acute SARS-CoV-2 infection did not lead to a decreased risk of PASC, with the exception of gastrointestinal presentations. Additional studies are needed to confirm the benefit of steroids and other immunomodulators in preventing long COVID.