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Multisystem Inflammatory Syndrome in Children Admitted to a Tertiary Pediatric Intensive Care Unit
Emrah Gün1, Tanıl Kendirli1, Edin Botan1
1Department of Pediatric Intensive Care, Division of Pediatric Intensive Care, Ankara University School of Medicine, Ankara, Turkey.
Insights
Multisystem inflammatory syndrome in children (MIS-C) can cause severe illness requiring pediatric intensive care. Prompt immunomodulatory treatment leads to favorable outcomes for most children with MIS-C.
Area of Science:
- Pediatric critical care
- Infectious diseases
- Immunology
Background:
- Multisystem inflammatory syndrome in children (MIS-C) is a serious condition with diverse symptoms, including fever, abdominal pain, rash, and potential cardiac dysfunction.
- MIS-C can progress to circulatory dysfunction, shock, and end-organ damage, posing a significant threat to children's lives.
- Understanding the clinical spectrum and outcomes of MIS-C in pediatric intensive care units (PICUs) is crucial for effective management.
Purpose of the Study:
- To analyze the clinical characteristics of children diagnosed with MIS-C admitted to a PICU.
- To evaluate the treatment strategies employed for MIS-C patients.
- To assess the outcomes and recovery patterns of children with MIS-C.
Main Methods:
- Retrospective analysis of clinical and laboratory data from 19 children admitted to the PICU with MIS-C between April 2020 and January 2021.
- Recording of presenting symptoms, laboratory findings, treatments received, and patient outcomes.
- Evaluation of intensive care interventions, including mechanical ventilation, inotropes, plasma exchange, and continuous renal replacement therapy.
Main Results:
- The study included 19 patients (57.8% male) with a median age of 12.5 years.
- Common manifestations included fever (100%), abdominal pain (94.7%), rash (63.1%), headache (68.4%), cardiac dysfunction (52.6%), and acute kidney injury (26.3%).
- Most patients required intensive care support; treatments included corticosteroids, intravenous immunoglobulin, and anticoagulants, with a single mortality.
Conclusions:
- MIS-C presents with varied clinical features and can lead to critical illness in children.
- Intensive care is frequently necessary for MIS-C patients.
- Immunomodulatory therapies demonstrate a generally favorable response in children with MIS-C.
Abstract:
Background Multisystem inflammatory syndrome in children (MIS-C) is characterized by persistent fever, abdominal pain, vomiting, diarrhea, rash, conjunctivitis, headaches, and mucocutaneous manifestations and it can cause circulatory dysfunction, resulting in hypotension, shock, and end-organ injury in the heart and other organs and possibly death. In this study, we aimed to analyze the clinical spectrum, treatment options and outcomes of children with MIS-C who were admitted to our pediatric intensive care (PICU). Materials and Methods Clinical and laboratory findings and treatment of the patients admitted to the PICU with MIS-C between April 2020 and January 2021 were recorded, and their outcomes were evaluated. Results Nineteen patients with a median age of 12.5 years (interquartile range (IQR): 5.8-14.0 years) were admitted. Eleven (57.8%) were males. The most frequent clinical and laboratory features were fever (100%), abdominal pain (94.7%), rash (63.1%), headache (68.4%), diarrhea (47.3%), seizure (10.5%), cardiac dysfunction (52.6%), acute kidney injury (26.3%), lymphopenia (84.2%), and thrombocytopenia (36.8%). However, 8 patients needed mechanical respiratory support, 11 patients needed inotropes, 2 patients needed plasma exchange, and 1 patient needed continuous renal replacement therapy. All patients received corticosteroids, 17 patients (89.2%) received intravenous immunoglobulin, 2 patients received anakinra, 10 patients received acetylsalicylic acid, and 6 patients received enoxaparin. Median PICU length of stay was 3 days (IQR: 2-5) and only one patient died. Conclusion In conclusion, MIS-C may present with a variety of clinical manifestations, and it can lead to life-threatening critical illness. Most children need intensive care and the response to immunomodulation is usually favorable.
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