Methylprednisolone use in children with severe pneumonia caused by severe acute respiratory syndrome coronavirus 2

Abstract

BackgroundThis 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.MethodsWe 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.ResultsFifty‐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.ConclusionThe 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.