Characterising approaches to steroid therapy in paediatric multisystem inflammatory syndrome temporally associated with SARS‐CoV ‐2

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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therapy is often used in the management of severe PIMS‐TS with the potential for HPA axis suppression and should be withdrawn carefully.

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