Institution: | 8. Department of Pediatrics, Anjo Kosei Hospital, Anjo, Japan;9. Department of Pediatrics, Okazaki City Hospital, Okazaki, Japan;10. Department of Pediatrics, Kasugai City Hospital, Kasugai, Japan;11. Department of Pediatrics, Chukyo Hospital, Nagoya, Japan;12. Department of Pediatrics, Tosei General Hospital, Seto, Aichi, Japan;13. Department of Pediatrics, Toyota Kosei Hospital, Toyota, Aichi, Japan;14. Department of Pediatrics, Nakatsugawa Municipal General Hospital, Nakatsugawa, Gifu, Japan;15. Department of Pediatrics, Nagoya Memorial Hospital, Nagoya, Japan;p. Department of Pediatrics, Japanese Red Cross Nagoya Daiichi Hospital, Nagoya, Japan;q. Department of Pediatrics, Hekinan Municipal Hospital, Hekinan, Aichi, Japan;r. Department of Pediatrics, Meitetsu Hospital, Nagoya, Japan;s. Department of Pediatrics, Tsushima City Hospital, Tsushima, Aichi, Japan;1. Department of Pediatrics, Nagoya University Graduate School of Medicine, Japan;2. Department of Pediatrics, Anjo Kosei Hospital, Japan;3. Department of Pediatrics, Nagoya Memorial Hospital, Japan;4. Department of Pediatrics, Okazaki City Hospital, Japan;5. Department of Pediatrics, Kasugai Municipal Hospital, Japan;6. Statistical Analysis Section, Center for Advanced Medicine and Clinical Research, Nagoya University Hospital, Japan;7. Division of Neonatology, Center for Maternal–Neonatal Care, Nagoya University Hospital, Japan |
Abstract: | BackgroundMycoplasma pneumoniae pneumonia (MPP) is generally a self-limiting disease, but it may become refractory. It is thought that refractory MPP is linked to the excessive immunologic responses of the host. Consequently, the use of adjunctive systemic corticosteroids may have beneficial effects. In this study, we compared the effects of high- and low-dose corticosteroid therapy in a pediatric population with refractory MPP.MethodsWe retrospectively collected data from 91 pediatric MPP patients treated with adjunctive systemic corticosteroids between April 2014 and October 2016. The patients were divided into the following two groups: high-dose corticosteroid group (2 mg/kg/day or more of prednisolone equivalents; n = 38) and low-dose corticosteroid group (<2 mg/kg/day; n = 53). Additionally, we compared the number of febrile days post-corticosteroid administration. We used 25 paired patients in a propensity score matching analysis to correct for confounding factors both by age and by days (from onset till corticosteroid therapy initiation).ResultsWe observed that in the high-dose corticosteroid group defervescence following corticosteroid therapy initiation was achieved significantly earlier and length of hospitalization was significantly shorter (0.8 ± 1.0 vs. 1.5 ± 1.4 days and 8.2 ± 2.4 vs. 10.7 ± 2.7 days, respectively). In the propensity score matching, we observed that significant differences in the length of fever following corticosteroid therapy initiation and hospitalization were still present. Further, neither of the groups developed corticosteroid-related adverse events.ConclusionOur results suggest that patients with refractory MPP treated with high-dose corticosteroid could achieve defervescence earlier and have a shorter hospitalization. |