Early steroid pulse therapy for children with suspected acute encephalopathy: A historical cohort study

Abstract

Background Steroid pulse therapy is widely used for virus-associated acute encephalopathy, especially the cytokine storm type; however, its effectiveness remains unknown. We aimed to investigate the effectiveness of early steroid pulse therapy for suspected acute encephalopathy in the presence of elevated aspartate aminotransferase (AST) levels. Methods We enrolled children admitted to Hyogo Children's Hospital between 2003 and 2017 with convulsions or impaired consciousness accompanied by fever (temperature > 38˚C). The inclusion criteria were: refractory status epilepticus or prolonged neurological abnormality or hemiplegia at six hours from onset, and AST elevation > 90 IU/L within six hours of onset. We excluded patients with a neurological history. We compared the prognosis between the groups with or without steroid pulse therapy within 24 hours. A good prognosis was defined as a Pediatric Cerebral Performance Category Scale (PCPC) score of 1–2 at the last evaluation, within 30 months of onset. Moreover, we analyzed the relationship between prognosis and time from onset to steroid pulse therapy. Results Fifteen patients with acute encephalopathy and five patients with febrile seizures were included in this study. Thirteen patients received steroid pulse therapy within 24 hours. There was no between-group difference in the proportion with a good prognosis. There was no significant correlation between PCPC and timing of steroid pulse therapy (rs = 0.253, p = 0.405). Conclusions Steroid pulse therapy within 24 hours did not improve the prognosis in children with suspected acute encephalopathy associated with AST elevation.