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Clinical Profile and Predictors of Outcome in Children with Acute Fulminant Myocarditis Receiving Intensive Care: A

Muralidharan Jayashree1, Manisha Patil1, Govindappa Benakatti2

  • 1Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Post Graduate Institute of Medical Education and Research, Chandigarh, India.

Journal of Pediatric Intensive Care
|August 5, 2022
PubMed

Insights

Acute fulminant myocarditis in children is serious, but intravenous immunoglobulin (IVIG) treatment may improve survival. Multiorgan dysfunction independently predicts mortality in these critical pediatric cases.

Area of Science:

  • Pediatric Cardiology
  • Critical Care Medicine
  • Immunology

Background:

  • Acute myocarditis in children presents significant morbidity and mortality risks.
  • Limited data exists on the efficacy of intravenous immunoglobulin (IVIG) for pediatric acute fulminant myocarditis (AFM).

Purpose of the Study:

  • To analyze the clinical and treatment profiles of children with AFM.
  • To identify predictors of outcome in pediatric AFM patients requiring intensive care.
  • To evaluate the impact of IVIG on survival in this population.

Main Methods:

  • Retrospective analysis of 120 children diagnosed with acute myocarditis between 2008 and 2018.
  • Detailed review of clinical data, treatment interventions, and outcomes.
  • Statistical analysis to identify factors associated with mortality and survival benefit.

Main Results:

  • AFM affected 89 children, with 60.7% presenting with hypotension and a median ejection fraction of 25%.
  • Mechanical ventilation (59.2%) and inotropic support (74.2%) were common intensive care interventions.
  • Mortality was 17.5%, with fever, shock, acidosis, AKI, transaminitis, and multiorgan dysfunction syndrome (MODS) predicting poor outcomes.
  • IVIG treatment was associated with significantly lower mortality (12.1% vs. 28.9%).

Conclusions:

  • MODS is an independent predictor of mortality in pediatric AFM.
  • IVIG treatment demonstrates a survival benefit in children with AFM.
  • Aggressive management of complications like MODS is crucial for improving prognosis in pediatric AFM.

Keywords:
acute myocarditischildrenintravenous immunoglobulinoutcomepredictors

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