Miranda João, Grilo Marta, Baptista Carolina, Melo Ana Reis E, Tavares Margarida, Ribeiro Augusto
Department of Pediatrics, Pediatric Intensive Care Unit, Centro Hospitalar Universitário São João, Porto, Portugal.
Department of Pediatrics, Immunodeficiency and Infectious Diseases Unit, Centro Hospitalar Universitário São João, Porto, Portugal.
J Pediatr Intensive Care. 2021 Dec 17;13(3):230-234. doi: 10.1055/s-0041-1740587. eCollection 2024 Sep.
Pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2; PIMS-TS) is a novel condition with persistent fever, inflammation, and single or multiorgan dysfunction. We aimed to describe the characteristics of children more severely affected and our clinical approach. We retrospectively collected clinical, treatment, and early outcomes data during a 3-month period in a pediatric intensive care unit (PICU) of a tertiary university hospital in Portugal. Twelve children who fulfilled the Royal College of Pediatrics and Child Health case definition were hospitalized, seven needed PICU admission. Median age was 13 years and three were overweight, with no other comorbidity. All had positive immunoglobulin G antibodies for SARS-CoV-2. All presented with prolonged fever, asthenia, hypotension, and shock. Other prominent symptoms were abdominal complaints and rash. All patients had leukocytosis, neutrophilia, and marked elevation of inflammatory markers. Cardiac involvement was observed in all patients with elevated levels of troponin and B-type natriuretic peptide along with left ventricular hypokinesis. Depressed left ventricular function was observed in four patients. All patients received broad-spectrum antibiotics, intravenous immunoglobulin, methylprednisolone, low-dose aspirin, and vasoactive medications. Four patients received prophylactic enoxaparin. All patients needed supplementary oxygen; however, high-flow oxygen therapy and noninvasive ventilatory support with positive end-expiratory pressure were required in three and two patients, respectively. Five patients required invasive mechanical ventilation. The mean duration of PICU stay was 7.1 days. The median Pediatric Risk of Mortality-III score was 9 and no mortality was observed. PIMS-TS demands a prompt and multidisciplinary approach. Risk factors, best clinical pathway, and long-term complications are still unknown.
儿童炎症性多系统综合征与严重急性呼吸综合征冠状病毒2（SARS-CoV-2；PIMS-TS）在时间上相关，是一种具有持续发热、炎症以及单器官或多器官功能障碍的新病症。我们旨在描述受影响更严重的儿童的特征以及我们的临床治疗方法。我们回顾性收集了葡萄牙一所三级大学医院儿科重症监护病房（PICU）3个月期间的临床、治疗及早期预后数据。12名符合皇家儿科学会和儿童健康学会病例定义的儿童住院治疗，7名需要入住PICU。中位年龄为13岁，3名超重，无其他合并症。所有患儿SARS-CoV-2免疫球蛋白G抗体均为阳性。所有患儿均出现持续发热、乏力、低血压和休克。其他突出症状为腹部不适和皮疹。所有患者均有白细胞增多、中性粒细胞增多以及炎症标志物显著升高。所有患者均观察到心脏受累，肌钙蛋白和B型利钠肽水平升高，同时伴有左心室运动减弱。4名患者观察到左心室功能减退。所有患者均接受了广谱抗生素、静脉注射免疫球蛋白、甲泼尼龙、小剂量阿司匹林和血管活性药物治疗。4名患者接受了预防性依诺肝素治疗。所有患者均需要补充氧气；然而，分别有3名和2名患者需要高流量氧疗和呼气末正压无创通气支持。5名患者需要有创机械通气。PICU平均住院时间为7.1天。儿科死亡率风险-III评分中位数为9，未观察到死亡病例。PIMS-TS需要迅速采取多学科方法。危险因素、最佳临床路径和长期并发症仍然未知。
