The effectiveness of high-dose versus low-dose corticosteroid therapy in children with acute respiratory distress syndrome: a randomized controlled study

Abstract Background Acute respiratory distress syndrome (ARDS) is an evident cause of morbidity and mortality in children admitted to pediatric intensive care units (PICUs). However, corticosteroid administration in ARDS remains controversial. This study evaluates the effects of high-dose versus low-dose methylprednisolone and the impact of early versus late corticosteroid initiation on clinical outcomes in pediatric ARDS. Methods This prospective, open-label, randomized study was conducted in the Ain Shams University Children’s Hospital PICU from October 2022 to June 2023. Forty children diagnosed with ARDS, per the 2012 Berlin definition, were randomized into two groups: high-dose methylprednisolone (30 mg/kg/day for 3 days) and low-dose methylprednisolone (2 mg/kg/day for 3 days). Clinical, laboratory, radiological, and biomarker assessments were performed before and 3 days after initiating therapy. Results There were no significant differences in clinical outcomes or length of PICU stay between both groups. Changes in alveolar procollagen peptide I ( p -value = 0.883), lung compliance ( p -value = 0.547), chest ultrasound BLUE score ( p -value = 0.192), and arterial blood gas parameters showed no significant differences between the groups. Change in lung ultrasound BLUE score (decrease more than 1) and lung compliance (increase more than 0.4) showed predictive values for outcome prognosis ( p -value < 0.001). Early initiation of corticosteroids was associated with significantly improved outcomes, with 100% survival, compared to late initiation (after 3 days), which was associated with 100% mortality ( p -value < 0.001). Conclusions Early corticosteroid initiation within 72 h of ARDS diagnosis significantly improves outcomes, irrespective of dose. Both high-dose and low-dose regimens demonstrated similar effects on clinical, biomarker, and radiological outcomes.