Department of Pediatrics, Division of Critical Care and Hospital Medicine, Columbia University Irving Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital of New York, New York, NY.
Department of Pediatrics, Division of Allergy, Immunology, and Rheumatology, Columbia University Irving Medical Center, New York-Presbyterian Morgan Stanley Children's Hospital of New York, New York, NY.
Pediatr Crit Care Med. 2021 Mar 1;22(3):e178-e191. doi: 10.1097/PCC.0000000000002598.
The disease caused by severe acute respiratory syndrome coronavirus 2, known as coronavirus disease 2019, has resulted in a global pandemic. Reports are emerging of a new severe hyperinflammatory syndrome related to coronavirus disease 2019 in children and adolescents. The Centers for Disease Control and Prevention has designated this disease multisystem inflammatory syndrome in children. Our objective was to develop a clinical inpatient protocol for the evaluation, management, and follow-up of patients with this syndrome.
The protocol was developed by a multidisciplinary team based on relevant literature related to coronavirus disease 2019, multisystem inflammatory syndrome in children, and related inflammatory syndromes, as well as our experience caring for children with multisystem inflammatory syndrome in children. Data were obtained on patients with multisystem inflammatory syndrome in children at our institution from the pre-protocol and post-protocol periods.
Our protocol was developed in order to identify cases of multisystem inflammatory syndrome in children with high sensitivity, stratify risk to guide treatment, recognize co-infectious or co-inflammatory processes, mitigate coronary artery abnormalities, and manage hyperinflammatory shock. Key elements of evaluation include case identification using broad clinical characteristics and comprehensive laboratory and imaging investigations. Treatment centers around glucocorticoids and IV immunoglobulin with biologic immunomodulators as adjuncts. Multidisciplinary follow-up after discharge is indicated to manage continued outpatient therapy and evaluate for disease sequelae. In nearly 2 months, we admitted 54 patients with multisystem inflammatory syndrome in children, all of whom survived without the need for invasive ventilatory or mechanical circulatory support. After institution of this protocol, patients received earlier treatment and had shorter lengths of hospital stay.
This report provides guidance to clinicians on evaluation, management, and follow-up of patients with a novel hyperinflammatory syndrome related to coronavirus disease 2019 known as multisystem inflammatory syndrome in children. It is based on the relevant literature and our experience. Instituting such a protocol during a global pandemic is feasible and is associated with patients receiving treatment and returning home more quickly.
由严重急性呼吸综合征冠状病毒 2 引起的疾病，即 2019 年冠状病毒病，已在全球范围内引发大流行。有报道称，与 2019 年冠状病毒病相关的一种新的严重高炎症综合征出现在儿童和青少年中。疾病控制与预防中心已将该病命名为儿童多系统炎症综合征。我们的目标是制定一种用于评估、管理和随访此类综合征患者的临床住院方案。
该方案由一个多学科团队制定，依据的是与 2019 年冠状病毒病、儿童多系统炎症综合征以及相关炎症综合征相关的相关文献，以及我们在照顾儿童多系统炎症综合征患者方面的经验。我们机构的儿童多系统炎症综合征患者的数据是在方案制定前后两个时期获得的。
我们制定该方案的目的是为了提高对儿童多系统炎症综合征的识别率，提高识别率，以达到高灵敏度，对病情进行分层以指导治疗，识别合并感染或合并炎症过程，减轻冠状动脉异常，并管理高炎症性休克。评估的关键要素包括使用广泛的临床特征和全面的实验室及影像学检查来识别病例。治疗的重点是使用糖皮质激素和静脉注射免疫球蛋白，并联合使用生物免疫调节剂。出院后的多学科随访对于管理持续的门诊治疗和评估疾病后遗症非常重要。在近 2 个月的时间里，我们收治了 54 例儿童多系统炎症综合征患者，所有患者均存活，无需使用有创性通气或机械循环支持。在实施该方案后，患者的治疗开始得更早，住院时间也更短。
本报告为临床医生提供了有关评估、管理和随访与 2019 年冠状病毒病相关的新型高炎症综合征，即儿童多系统炎症综合征的指导。该方案基于相关文献和我们的经验。在全球大流行期间实施这样的方案是可行的，并且可以使患者更快地接受治疗并返回家中。
