Glucocorticoid therapy may not be efficacious for pediatric COVID-19 without MIS-C

1. Hospital length of stay did not differ for children who received early steroids for COVID without non-multisystem inflammatory syndrome compared to those who did not receive early steroids

Evidence Rating Level: 2 (Good)

Although most children affected by COVID only suffer from mild illness, severe cases that confer significant mortality and morbidity have certainly been described. Due to its lower relative incidence however, there lacks substantial literature covering therapeutic options for severe cases. Currently, there have been management principles of treating multisystem inflammatory syndrome (MIS-C) applied to the treatment of severe COVID. This typically includes IV immunoglobulins as well as steroids, which in adult studies, have found modest effect. While COVID-19 illness can be associated with MIS-C, severe, non-MIS-C COVID-19 can certainly manifest as well. There has been a lack of past data that have directly examined the therapeutic effect of these treatments for non-MIS-C COVID infections in children, and as such, their benefits and risks are currently poorly characterized. This retrospective cohort study sought to address this gap by comparing pediatric patients hospitalized with non-MISC-COVID-19 (either confirmed with lab confirmation or high clinical suspicion) who received steroids on or before day 2 of hospital admission to those who received steroids after day 2. Length of stay was the primary outcome, with secondary outcomes including nosocomial bacterial infection, ventilator or inotrope requirement by 2 or later, number of days on inotropes, fever defervescence by day 3 and inflammatory markers. In total, the final cohort included 1163 patients from 58 different hospitals, 184 received steroids within 2 days of admission and 979 did not. Steroid treatment within the first 2 days of hospital admission was not significantly associated with length of stay (exponentiated coefficient, 0.94; 95% CI, 0.81-1.09; P = .42). Secondary outcomes also showed no significant associations, however were difficult to complete sophisticated analyses on due to low numbers. Hospital stay is influenced by many factors, making it difficult to determine the benefit or harm of steroid treatment. Preliminary studies here however, demonstrate that the treatment principle of early glucocorticoid administration in MIS-C may not be directly applicable to the treatment of non-MIS-C COVID infections, though this requires further exploration in future studies.

Click to read the study in JAMA Pediatrics

Image: PD

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