M3C-Necker Enfants Malades, AP-HP, Paris, France (Z.B., M.M., F.B., D.K., A.L., S.A., J.A., M.G., M.O., S.M.-M., A.M., L.H., S.R., D.B.).
Université de Paris, France (Z.B., L.H., S.R., D.B.).
Circulation. 2020 Aug 4;142(5):429-436. doi: 10.1161/CIRCULATIONAHA.120.048360. Epub 2020 May 17.
Cardiac injury and myocarditis have been described in adults with coronavirus disease 2019 (COVID-19). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children is typically minimally symptomatic. We report a series of febrile pediatric patients with acute heart failure potentially associated with SARS-CoV-2 infection and the multisystem inflammatory syndrome in children as defined by the US Centers for Disease Control and Prevention.
Over a 2-month period, contemporary with the SARS-CoV-2 pandemic in France and Switzerland, we retrospectively collected clinical, biological, therapeutic, and early outcomes data in children who were admitted to pediatric intensive care units in 14 centers for cardiogenic shock, left ventricular dysfunction, and severe inflammatory state.
Thirty-five children were identified and included in the study. Median age at admission was 10 years (range, 2-16 years). Comorbidities were present in 28%, including asthma and overweight. Gastrointestinal symptoms were prominent. Left ventricular ejection fraction was <30% in one-third; 80% required inotropic support with 28% treated with extracorporeal membrane oxygenation. Inflammation markers were suggestive of cytokine storm (interleukin-6 median, 135 pg/mL) and macrophage activation (D-dimer median, 5284 ng/mL). Mean BNP (B-type natriuretic peptide) was elevated (5743 pg/mL). Thirty-one of 35 patients (88%) tested positive for SARS-CoV-2 infection by polymerase chain reaction of nasopharyngeal swab or serology. All patients received intravenous immunoglobulin, with adjunctive steroid therapy used in one-third. Left ventricular function was restored in the 25 of 35 of those discharged from the intensive care unit. No patient died, and all patients treated with extracorporeal membrane oxygenation were successfully weaned.
Children may experience an acute cardiac decompensation caused by severe inflammatory state after SARS-CoV-2 infection (multisystem inflammatory syndrome in children). Treatment with immunoglobulin appears to be associated with recovery of left ventricular systolic function.
新型冠状病毒病 2019（COVID-19）可导致成人发生心肌损伤和心肌炎。儿童感染严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）通常症状轻微。我们报告了一系列发热儿科患者，他们可能因 SARS-CoV-2 感染而出现急性心力衰竭和儿童多系统炎症综合征，这是美国疾病控制与预防中心定义的。
在法国和瑞士 SARS-CoV-2 大流行期间的 2 个月内，我们回顾性地收集了 14 个中心的儿科重症监护病房收治的因心源性休克、左心室功能障碍和严重炎症状态而入院的儿童的临床、生物学、治疗和早期结局数据。
共确定 35 名儿童纳入研究。入院时的中位年龄为 10 岁（范围，2-16 岁）。28%的患儿存在合并症，包括哮喘和超重。胃肠道症状突出。三分之一的左心室射血分数<30%；80%需要正性肌力支持，28%接受体外膜氧合治疗。炎症标志物提示细胞因子风暴（白细胞介素-6 中位数 135pg/ml）和巨噬细胞激活（D-二聚体中位数 5284ng/ml）。平均 BNP（B 型利钠肽）升高（5743pg/ml）。35 名患者中有 31 名（88%）通过鼻咽拭子聚合酶链反应或血清学检测 SARS-CoV-2 感染呈阳性。所有患者均接受静脉注射免疫球蛋白治疗，三分之一患者辅助使用皮质类固醇治疗。从重症监护病房出院的 25 名患者中左心室功能恢复。无患者死亡，所有接受体外膜氧合治疗的患者均成功撤机。
儿童可能因 SARS-CoV-2 感染后发生严重炎症状态导致急性心功能失代偿（儿童多系统炎症综合征）。免疫球蛋白治疗似乎与左心室收缩功能恢复有关。
