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Characterising approaches to steroid therapy in paediatric multisystem inflammatory syndrome temporally associated
Sinéad M McGlacken-Byrne1,2, Mae Johnson3, Justin Penner4
1Department of Endocrinology, Great Ormond Street Hospital, London, United Kingdom.
Insights
Steroid therapy is frequently used for severe pediatric multisystem inflammatory syndrome (PIMS-TS), with longer treatment durations correlating to increased intensive care needs. Careful withdrawal is advised due to potential HPA axis suppression.
Area of Science:
- Pediatric rheumatology
- Infectious disease epidemiology
- Pharmacology
Background:
- Paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS) is a serious condition requiring effective management.
- Steroid therapy is a cornerstone treatment, but its optimal use and impact on disease severity require further elucidation.
Purpose of the Study:
- To describe current steroid therapy approaches for PIMS-TS in a UK tertiary pediatric hospital.
- To examine the association between steroid use and key clinical markers of PIMS-TS severity.
Main Methods:
- Retrospective review of children (<18 years) diagnosed with PIMS-TS.
- Data collection on steroid therapy details (type, duration, dose) and hypothalamo-pituitary-adrenal (HPA) axis monitoring.
- Statistical analysis of steroid exposure against pediatric intensive care unit admission, mechanical ventilation, and inotropic support.
Main Results:
- 84.9% of children received steroid therapy, with a median duration of 26 days.
- Steroid therapy duration positively correlated with pediatric intensive care unit admission and mechanical ventilation duration.
- Children on steroid therapy were more likely to receive inotropic support.
Conclusions:
- Prolonged, high-dose steroid therapy is common in severe PIMS-TS.
- Potential for HPA axis suppression necessitates careful steroid withdrawal strategies.
Aim:
We describe approaches to steroid therapy use in paediatric multisystem inflammatory syndrome temporally associated with SARS-CoV-2 (PIMS-TS) and examine the association between steroid therapy and key clinical markers of severity.
Methods:
We conducted a retrospective review of children (<18 years) admitted to a tertiary paediatric hospital in the UK with PIMS-TS. We collected data on if and why steroid therapy was used; the duration, type and dosing of steroids prescribed; and approaches to hypothalamo-pituitary-adrenal (HPA) axis monitoring, if performed. We examined associations between steroid exposure/total steroid dose (mg/m2 /day) and paediatric intensive care unit admission, mechanical ventilation and inotropic support.
Results:
Steroid therapy was commenced in most children (84.9%, n = 104) with a median total daily steroid dose (hydrocortisone equivalent) of 271.0 mg/m2 /day (interquartile range 232.5-355.5) and treatment length of 26.0 days (interquartile range 19.0-32.0). Dosing regimens predominantly involved a short course of high-dose methylprednisolone followed by tapering oral prednisolone. Basal and/or dynamic testing of the HPA axis was conducted in a minority (11.8%, n = 15) and was normal. Duration of steroid therapy correlated positively with durations of paediatric intensive care unit admission (r = 0.407, P < 0.001) and mechanical ventilation (r = 0.797, P < 0.001). A greater proportion of children receiving steroid therapy also received inotropic support compared to those that did not receive steroid therapy (71.4% vs. 45.5%, P = 0.025).
Conclusion:
Prolonged, high-dose steroid therapy is often used in the management of severe PIMS-TS with the potential for HPA axis suppression and should be withdrawn carefully.
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