Critical Care Course of Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 and...

Area of Science:

• Pediatric critical care medicine
• Infectious diseases
• Immunology

Background:

• A novel hyperinflammatory syndrome, pediatric inflammatory multisystem syndrome (PIMS), has been observed in children following coronavirus disease 2019 (COVID-19).
• This syndrome is temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.

Purpose of the Study:

• To describe the critical care course of children diagnosed with PIMS.
• To analyze the trajectory of illness before and after immunomodulatory treatments.

Main Methods:

• Analysis of 10 pediatric patients meeting the U.K. Royal College of Pediatrics and Child Health case definition for PIMS.
• Assessment of clinical data, inflammatory markers, and cardiac function during critical care admission.
• Review of treatments including inotropic/vasopressor support, intravenous immunoglobulin, and high-dose steroids.

Main Results:

• All patients tested positive for SARS-CoV-2 IgG antibodies.
• 100% required cardiovascular support (inotropic or vasopressor), though only 20% needed ventilation.
• Significantly elevated inflammatory markers (CRP, ferritin) and cardiac biomarkers (troponin-I) were noted.
• Myocardial dysfunction was present in 8/10 patients (moderate in 6, severe in 2).
• Critical care duration was brief (3-5 days) for all patients.
• Eight patients received intravenous immunoglobulin, and six received high-dose steroids.

Conclusions:

• Children with PIMS present with significant hyperinflammation and cardiac involvement requiring critical care.
• Despite severe illness, critical care stays are typically short.
• Clinical improvement and cardiovascular stability were observed irrespective of immunomodulatory treatment, suggesting a complex interplay of factors in recovery.