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Pediatric Multisystemic Inflammatory Syndrome Temporarily associated with COVID-19: Clinical characteristics and
Felipe Yagnam R1, Giannina Izquierdo C2, Rodolfo Villena M2
1Hospital de niños Dr. Exequiel González Cortés, Santiago, Chile.
Insights
Pediatric multisystem inflammatory syndrome (MIS-C) associated with COVID-19 can be severe. Early suspicion and treatment in pediatric intensive care units lead to favorable outcomes.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Immunology
Background:
- Pediatric multisystem inflammatory syndrome temporarily associated with COVID-19 (MIS-C) first described in April 2020.
- MIS-C can present severely, necessitating critical care.
Purpose of the Study:
- To characterize clinical, laboratory, and management features of severe MIS-C in a pediatric intensive care unit.
- To compare Kawasaki and non-Kawasaki phenotypes in severe MIS-C.
Main Methods:
- Prospective descriptive study of 20 children with severe MIS-C.
- Treatment involved phased immunoglobulin and methylprednisolone based on clinical response.
- Data collected included epidemiology, clinical presentation, labs, imaging, and phenotype classification.
Main Results:
- 90% of patients had SARS-CoV-2 detection; 75% showed Kawasaki phenotype.
- Common symptoms included fever and gastrointestinal issues; 90% experienced shock requiring critical care.
- Patients exhibited lymphopenia, hypoalbuminemia, coagulation issues, and elevated inflammatory markers; 80% had echocardiographic alterations.
Conclusions:
- MIS-C is a potentially life-threatening pediatric illness.
- Early suspicion, immunomodulatory therapy, and critical care are crucial for optimal prognosis.
- A multidisciplinary approach is recommended for managing MIS-C.
Introduction:
In April 2020, the pediatric multisystem inflammatory syndrome temporarily associated with COVID-19 (MIS-C) was described for the first time. MIS-C could have a severe course and may require critical care support.
Objective:
To describe the clinical, laboratory, and management characteristics of hospitalized children who meet MIS-C criteria with severe presentation in a pediatric critical pa tient unit.
Patients And Method:
Descriptive prospective study of children with severe MIS-C mana ged by treatment phases with immunoglobulin and methylprednisolone, according to their clinical response. Epidemiological, clinical, laboratory and imaging data were obtained. Phenotypes were classified into Kawasaki and not Kawasaki, comparing their findings.
Results:
20 patients were analy zed, the median age was 6 years, 60% were female, and 40% presented comorbidity. SARS-CoV-2 was detected in 90% of the patients. They presented fever as the first symptom, followed by brief and early gastrointestinal symptoms (70%). 75% presented the Kawasaki phenotype. They evolved with lymphopenia, hypoalbuminemia, coagulation alterations, and elevated systemic and cardiac in flammatory parameters. 80% of the cases presented echocardiographic alterations and 90% shock that required critical care support. All the patients had a short and favorable evolution. All patients responded to the established therapy, but 40% required a second phase of treatment. There were no differences when comparing phenotypes. No deaths were reported.
Conclusion:
MIS-C is a new childhood disease whose presentation could be life-threatening. It requires early suspicion, immuno modulatory management, critical care support, and a multidisciplinary approach to obtain the best results and optimize its prognosis.
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