Related Experiment Video
Updated: Jul 2, 2025
Halogenated Agent Delivery in Porcine Model of Acute Respiratory Distress Syndrome via an Intensive Care Unit Type Device
Published on: September 24, 2020
Risk Factors Associated with Intensive Care Admission in Children with Severe Acute Respiratory Syndrome Coronavirus
Jaime Fernández-Sarmiento1, Lorena Acevedo1, Laura Fernanda Niño-Serna2
1Department of Pediatrics and Intensive Care, Fundación Cardioinfantil-Instituto de Cardiología, Universidad de La Sabana, Bogotá, Colombia.
Insights
Multisystem inflammatory syndrome in children (MIS-C) in Latin America shows higher PICU admission rates and mortality compared to high-income nations. Key risk factors for PICU transfer include age over six, shock, seizures, and inflammatory markers.
Area of Science:
- Pediatric critical care
- Infectious diseases
- Epidemiology
Background:
- Multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19 presents with variable severity.
- Mortality rates for MIS-C are notably lower in high-income countries compared to other regions.
- Understanding MIS-C characteristics in Latin America is crucial due to regional variations in healthcare access and disease burden.
Purpose of the Study:
- To characterize pediatric intensive care unit (PICU) patients with MIS-C in Latin America.
- To compare MIS-C patients in the PICU versus those on general wards.
- To identify factors associated with MIS-C severity, outcomes, and treatment in Latin American children.
Main Methods:
- An observational ambispective cohort study was conducted across 16 Latin American countries.
- Data were collected from 84 hospitals within the REKAMLATINA network between January 2020 and June 2022.
- Included were 1239 children aged 1 month to 18 years diagnosed with MIS-C.
Main Results:
- 48% of MIS-C patients required PICU admission, presenting with higher rates of myocardial dysfunction (20% vs 4%).
- PICU patients frequently needed vasoactive drugs (83.4%) and invasive mechanical ventilation (43.4%), primarily due to respiratory failure and pneumonia.
- Factors predicting PICU transfer included age >6 years, shock, seizures, thrombocytopenia, elevated C-reactive protein, and chest X-ray abnormalities.
- Overall mortality was 4.8%, significantly higher than in high-income countries.
Conclusions:
- Children over six with shock, seizures, robust inflammatory response, and chest X-ray abnormalities face the highest risk of PICU admission for MIS-C in Latin America.
- The mortality rate for MIS-C in this Latin American cohort is five times greater than reported in high-income countries.
- Despite challenges, a high proportion of patients received adequate treatment, highlighting the need for continued vigilance and resource allocation.
Abstract:
Background: Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 varies widely in its presentation and severity, with low mortality in high-income countries. In this study in 16 Latin American countries, we sought to characterize patients with MIS-C in the pediatric intensive care unit (PICU) compared with those hospitalized on the general wards and analyze the factors associated with severity, outcomes, and treatment received. Study Design: An observational ambispective cohort study was conducted including children 1 month to 18 years old in 84 hospitals from the REKAMLATINA network from January 2020 to June 2022. Results: A total of 1239 children with MIS-C were included. The median age was 6.5 years (IQR 2.5-10.1). Eighty-four percent (1043/1239) were previously healthy. Forty-eight percent (590/1239) were admitted to the PICU. These patients had more myocardial dysfunction (20% vs 4%; P < 0.01) with no difference in the frequency of coronary abnormalities (P = 0.77) when compared to general ward subjects. Of the children in the PICU, 83.4% (494/589) required vasoactive drugs, and 43.4% (256/589) invasive mechanical ventilation, due to respiratory failure and pneumonia (57% vs 32%; P = 0.01). On multivariate analysis, the factors associated with the need for PICU transfer were age over 6 years (aOR 1.76 95% CI 1.25-2.49), shock (aOR 7.06 95% CI 5.14-9.80), seizures (aOR 2.44 95% CI 1.14-5.36), thrombocytopenia (aOR 2.43 95% CI 1.77-3.34), elevated C-reactive protein (aOR 1.89 95% CI 1.29-2.79), and chest x-ray abnormalities (aOR 2.29 95% CI 1.67-3.13). The overall mortality was 4.8%. Conclusions: Children with MIS-C who have the highest risk of being admitted to a PICU in Latin American countries are those over age six, with shock, seizures, a more robust inflammatory response, and chest x-ray abnormalities. The mortality rate is five times greater when compared with high-income countries, despite a high proportion of patients receiving adequate treatment.
Related Concept Videos
01:30Acute Respiratory Failure-III
01:21Acute Respiratory Failure-II
The underlying physiological abnormalities that contribute to hypoxemic respiratory failure include:
01:29Acute Respiratory Failure-V
Ensure that patients are monitored continuously for their response to therapy, including changes in...
01:30Pneumonia I: Introduction
Risk Factors
Various factors influence the likelihood of developing pneumonia. Age plays a crucial role, with infants, children under two, and individuals over 65 at increased risk due to their...
01:21Acute Respiratory Failure-I
Definition: It is defined by specific criteria based on blood gas measurements. Hypoxemia happens when the partial pressure of oxygen (PaO2) falls below 60 mmHg. At the same time,...
01:17Pulmonary Cycle: Exhalation