Division of Pediatric Emergency and Intensive Care, Department of Pediatrics, Advanced Pediatrics Centre, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
Department of Cardiology, Postgraduate Institute of Medical Education and Research (PGIMER), Chandigarh 160012, India.
J Trop Pediatr. 2021 Jul 2;67(3). doi: 10.1093/tropej/fmab055.
To describe the intensive care needs and outcome of multisystem inflammatory syndrome in children (MIS-C).
This retrospective study was conducted in the pediatric emergency, pediatric intensive care unit (PICUs) and the coronavirus disease 2019 (COVID 19) hospital of a tertiary teaching and referral hospital in North India over a period of 5 months (September 2020 to January 2021). Clinical details, laboratory investigations, intensive care needs, treatment and short-term outcome were recorded.
Forty children with median interquartile range age of 7 (5-10) years were enrolled. The common clinical features were fever (97.5%), mucocutaneous involvement (80%), abdominal (72.5%) and respiratory (50%) symptoms. Shock was noted in 80% children. Most cases (85%) required PICU admission where they received nasal prong oxygen (40%), non-invasive (22.5%) and invasive (22.5%) ventilation and vasoactive drug support (72.5%). The confirmation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) exposure was in the form of positive serology (66.7%), reverse transcriptase polymerase chain reaction (10%), and contact with SARS-CoV-2 positive case (12.5%). The common echocardiographic findings included myocardial dysfunction (ejection fraction <55%; 72.5%), and coronary artery dilatation or aneurysm (22.5%). The immunomodulatory treatment included intravenous immunoglobulin (2 g/kg) (100%) and steroids (methylprednisolone 10-30 mg/kg/day for 3-5 days) (85%). Aspirin was used in 80% and heparin (low molecular weight) in 7.5% cases. Two children died (5%) and median duration of PICU and hospital stay in survivors were 5 (2-8) and 7 (4-9) days, respectively. Children with shock showed higher total leucocyte count and higher rates of myocardial dysfunction.
Cardiovascular involvement and shock are predominant features in severe disease. Early diagnosis can be challenging given the overlapping features with other diagnoses. A high index of suspicion is warranted in children with constellation of fever, mucocutaneous, gastrointestinal and cardiovascular involvement alongwith evidence of systemic inflammation and recent or concurrent SARS-CoV-2 infection. The short-term outcome is good with appropriate organ support therapies and immunomodulation.
描述儿童多系统炎症综合征（MIS-C）的重症监护需求和结局。
本回顾性研究在印度北部一家三级教学和转诊医院的儿科急诊、儿科重症监护病房（PICU）和 2019 年冠状病毒病（COVID-19）医院进行，研究时间为 5 个月（2020 年 9 月至 2021 年 1 月）。记录了临床细节、实验室检查、重症监护需求、治疗和短期结局。
共纳入 40 名年龄中位数为 7（5-10）岁的儿童。常见的临床特征是发热（97.5%）、黏膜皮肤受累（80%）、腹部（72.5%）和呼吸道（50%）症状。80%的患儿出现休克。大多数患儿（85%）需要入住 PICU，其中 40%接受鼻插管吸氧，22.5%和 22.5%接受无创通气和有创通气，72.5%接受血管活性药物支持。严重急性呼吸综合征冠状病毒 2（SARS-CoV-2）暴露的确认形式为血清学阳性（66.7%）、逆转录酶聚合酶链反应（10%）和与 SARS-CoV-2 阳性病例接触（12.5%）。常见的超声心动图表现包括心肌功能障碍（射血分数<55%；72.5%）和冠状动脉扩张或动脉瘤（22.5%）。免疫调节治疗包括静脉注射免疫球蛋白（2g/kg）（100%）和皮质类固醇（甲泼尼龙 10-30mg/kg/天，使用 3-5 天）（85%）。80%的患儿使用阿司匹林，7.5%的患儿使用肝素（低分子肝素）。2 名患儿死亡（5%），幸存者的 PICU 住院时间和住院时间中位数分别为 5（2-8）天和 7（4-9）天。有休克的患儿白细胞总数较高，心肌功能障碍发生率较高。
心血管受累和休克是严重疾病的主要特征。鉴于与其他诊断的重叠特征，早期诊断具有挑战性。对于有发热、黏膜皮肤、胃肠道和心血管受累，伴有全身炎症和近期或同时 SARS-CoV-2 感染证据的儿童，应高度怀疑。适当的器官支持治疗和免疫调节可获得良好的短期结局。
