Efficacy of Intravenous Immunoglobulin and Corticosteroids in Pediatric Myocarditis: A Comprehensive Prospective...

Pediatric myocarditis remains a rare but serious condition with high morbidity and mortality. The potential role of intravenous immunoglobulin (IVIG) and corticosteroids remains debated. In this prospective cohort study, 84 children with clinically diagnosed myocarditis were enrolled and followed for one year. Patients received supportive therapy (n = 29), corticosteroids (n = 21), IVIG (n = 19), or combination therapy (IVIG + corticosteroids, n = 15), according to clinical judgment. Short- and long-term outcomes were compared. Improvement was defined as LVEF ≥ 55% or, for baseline LVEF < 45%, an absolute increase ≥ 10 percentage points with normalization of wall motion/fractional shortening. Outcomes were analyzed using chi-square/Fisher's exact tests, with risk ratios (RR), odds ratios (OR), and 95% confidence intervals (CIs) reported. Survival was assessed by Kaplan-Meier analysis. At one year, improvement occurred in 35% of supportive, 48% of corticosteroid, 58% of IVIG, and 67% of combination therapy patients (global χ² p = 0.177). Compared with supportive care, the point estimate for improvement was highest in the combination therapy group (RR 1.93, 95% CI 0.98-3.83; OR 3.68, 95% CI 0.86-17.91), however, the difference was not statistically significant (Fisher p = 0.059). Mortality rates were 35%, 24%, 26%, and 20%, respectively, also without significant differences between groups. Conclusions: No statistically significant differences in improvement or survival were observed between treatment strategies. The reported point estimates are descriptive and should not be interpreted as evidence of treatment superiority. Larger multicenter or randomized studies are needed.