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Multisystem Inflammatory Syndrome in Children: Clinical Features and Management-Intensive Care Experience from a
Lakshmi Shobhavat1, Rekha Solomon1, Sudha Rao2
1Department of PICU, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India.
Insights
Multisystem inflammatory syndrome in children (MIS-C) is a serious condition associated with COVID-19. Early treatment with steroids and IVIG improved outcomes in critically ill children.
Area of Science:
- Pediatric critical care
- Infectious diseases
- Pediatric rheumatology
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is an emerging condition linked to SARS-CoV-2.
- Increasing global reports highlight the need to understand MIS-C's clinical spectrum and management.
Purpose of the Study:
- To describe the clinical features and management of MIS-C patients requiring pediatric intensive care.
- To evaluate the outcomes of MIS-C patients treated with immunomodulatory therapies.
Main Methods:
- Retrospective study of 21 children meeting WHO criteria for MIS-C admitted to the pediatric intensive care unit.
- Data collected on clinical presentation, laboratory markers, echocardiography, and treatments received.
- Analysis of outcomes including mortality and discharge status.
Main Results:
- The cohort comprised 21 children (median age 7 years), predominantly without comorbidities.
- Common symptoms included fever (100%) and gastrointestinal issues (76%). Most presented with shock (95%) requiring significant cardiovascular support.
- Elevated inflammatory markers (CRP, ferritin, IL-6) were observed. Cardiac involvement (left ventricular dysfunction, coronary dilatation) was noted. 86% were discharged, 14% died.
Conclusions:
- MIS-C in this cohort primarily affected previously healthy children, presenting with fever, GI symptoms, and shock.
- Aggressive management of shock combined with immune modulation (methylprednisolone, IVIG) was crucial.
- This intensive care experience underscores the severity of MIS-C and the importance of prompt, multidisciplinary management.
Background:
Multisystem inflammatory syndrome (MIS) associated with severe acute respiratory syndrome coronavirus (SARS-CoV-2) (MIS-C) in children is being increasingly reported across the world.
Materials And Methods:
Children fulfilling the World Health Organization criteria of MIS-C needing pediatric intensive care unit between April 15 and July 26, 2020 were studied.
Results:
There were 21 patients with median age of 7 years [interquartile range (IQR) 1.9-12.1], of which 11 were females. SARS-CoV-2 real-time polymerase chain reaction positive in 8/21 and/or antibody positive 16/21. Fever was present in all patients, and gastrointestinal symptoms being second most frequent (16/21). One child had aplastic anemia, while the rest had no comorbidities. Nearly all presented with shock (n = 20/21) and 90% needed vasoactive drugs with a median Vasoactive Inotropic Score of 40 (IQR 20-95). Thirteen children needed ventilatory support and one needed peritoneal dialysis. Nine children had left ventricular dysfunction and five had dilatation of coronaries on echocardiography. Inflammatory markers C-reactive protein [98 mg/dL (IQR 89-119)], serum ferritin [710 mg/dL (IQR 422-1,609)], and serum interleukin-6 levels [215 ng/L (IQR 43-527)] were uniformly elevated. Eighteen children received pulse methyl-prednisolone, eleven intravenous immunoglobulins, and four tocilizumab. Eighteen children (86%) were discharged home while three died.
Conclusion:
In our cohort, MIS-C was seen in previously healthy children with fever, gastrointestinal symptoms, and shock. Early and aggressive management of shock and immune modulation with methyl-prednisolone and intravenous immunoglobulin were used.
How To Cite This Article:
Shobhavat L, Solomon R, Rao S, Bhagat I, Prabhu S, Prabhu S, et al. Multisystem Inflammatory Syndrome in Children: Clinical Features and Management-Intensive Care Experience from a Pediatric Public Hospital in Western India. Indian J Crit Care Med 2020;24(11):1089-1094.
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