Department of Surgery, Tulane University, School of Medicine, New Orleans, LA, USA.
Genetics Unit, Department of Histology and Cell Biology, Faculty of Medicine, Suez Canal University, Ismailia, Egypt.
World J Pediatr. 2021 Apr;17(2):141-151. doi: 10.1007/s12519-021-00419-y. Epub 2021 Feb 20.
We aimed to systematically review the clinical and laboratory features of patients with the multisystem inflammatory syndrome in pediatrics diagnosed during the COVID-19 pandemic.
A literature search in Web of Science, PubMed, Scopus, and Science Direct was made up to June 29, 2020.
Analysis of 15 articles (318 COVID-19 patients) revealed that although many patients presented with the typical multisystem inflammatory syndrome in pediatrics, Kawasaki-like features as fever (82.4%), polymorphous maculopapular exanthema (63.7%), oral mucosal changes (58.1%), conjunctival injections (56.0%), edematous extremities (40.7%), and cervical lymphadenopathy (28.5%), atypical gastrointestinal (79.4%) and neurocognitive symptoms (31.8%) were also common. They had elevated serum lactic acid dehydrogenase, D-dimer, C-reactive protein, procalcitonin, interleukin-6, troponin I levels, and lymphopenia. Nearly 77.0% developed hypotension, and 68.1% went into shock, while 41.1% had acute kidney injury. Intensive care was needed in 73.7% of cases; 13.2% were intubated, and 37.9% required mechanical ventilation. Intravenous immunoglobulins and steroids were given in 87.7% and 56.9% of the patients, respectively, and anticoagulants were utilized in 67.0%. Pediatric patients were discharged after a hospital stay of 6.77 days on average (95% CI 4.93-8.6).
Recognizing the typical and atypical presentation of the multisystem inflammatory syndrome in pediatric COVID-19 patients has important implications in identifying children at risk. Monitoring cardiac and renal decompensation and early interventions in patients with multisystem inflammatory syndrome is critical to prevent further morbidity.
我们旨在系统地回顾 COVID-19 大流行期间诊断为儿童多系统炎症综合征的患者的临床和实验室特征。
截至 2020 年 6 月 29 日，我们在 Web of Science、PubMed、Scopus 和 Science Direct 上进行了文献检索。
对 15 篇文章（318 例 COVID-19 患者）的分析表明，尽管许多患者表现出典型的儿童多系统炎症综合征，但也常见川崎病样特征，如发热（82.4%）、多形性斑丘疹（63.7%）、口腔黏膜改变（58.1%）、结膜充血（56.0%）、水肿性四肢（40.7%）和颈部淋巴结肿大（28.5%），非典型胃肠道（79.4%）和神经认知症状（31.8%）也很常见。他们的血清乳酸脱氢酶、D-二聚体、C 反应蛋白、降钙素原、白细胞介素-6、肌钙蛋白 I 水平和淋巴细胞减少。近 77.0%的患者出现低血压，68.1%的患者发生休克，41.1%的患者发生急性肾损伤。73.7%的病例需要重症监护；13.2%的患者需要插管，37.9%的患者需要机械通气。分别有 87.7%和 56.9%的患者给予静脉注射免疫球蛋白和皮质类固醇，67.0%的患者使用抗凝剂。儿科患者的平均住院时间为 6.77 天（95%CI 4.93-8.6）。
认识到 COVID-19 儿童多系统炎症综合征的典型和非典型表现对识别有风险的儿童具有重要意义。监测儿童多系统炎症综合征患者的心脏和肾脏失代偿并早期干预对预防进一步发病至关重要。
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