Critical care course of pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 and response to immunomodulation.
Richens, Nicholas Kanthimathinathan, Hari Krishnan Sontakke, Sanket Chikermane, Ashish Jyothish, Deepthi Hackett, Scott Welch, Steven B Al-Abadi, Eslam Duncan, Heather P Richter, Alex G
Richens, Nicholas
Kanthimathinathan, Hari Krishnan
Sontakke, Sanket
Chikermane, Ashish
Jyothish, Deepthi
Hackett, Scott
Welch, Steven B
Al-Abadi, Eslam
Duncan, Heather P
Richter, Alex G
Abstract
We describe the critical care course of children with a novel hyperinflammatory syndrome associated with coronavirus disease 2019 (COVID-19) pediatric inflammatory multisystem syndrome temporally associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), with focus on trajectory before and after immunomodulation. Overall, 10 patients who met the U.K. Royal College of Pediatrics and Child Health case definition during a 2-month study period were analyzed. All tested positive for SARS-CoV-2 IgG antibody. Although only 20% were ventilated, 100% required inotropic or vasopressor support. All children had significantly raised inflammatory markers with a median C-reactive protein of 248 (175-263) mg/L, ferritin of 1,561 (726-2,255) µg/L, and troponin-I of 723 (351-2,235) ng/L. Six patients had moderately impaired myocardial function and two had severe impairment. None needed extracorporeal membrane oxygenation. Despite severe illness only a brief period of critical care support of 3 to 5 days was required. Eight received at least one dose of intravenous immunoglobulin. Six received high-dose steroids. Clinical improvement including cardiovascular stability and reduction in inflammatory markers may have occurred with and without immunomodulation.
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Date
2020-12-04
Type
Article
Subject
Intensive care, Cardiology, Rheumatology, Microbiology. Immunology
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Citation
Richens N, Kanthimathinathan HK, Sontakke S, Chikermane A, Jyothish D, Hackett S, Welch SB, Al-Abadi E, Duncan HP, Richter AG, Scholefield BR. Critical Care Course of Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 and Response to Immunomodulation. J Pediatr Intensive Care. 2020 Dec 4;11(2):124-129. doi: 10.1055/s-0040-1721456
Journal / Source Title
Journal of Pediatric Intensive Care
DOI
10.1055/s-0040-1721456
PMID
35734206
Publisher
Thieme
Publisher’s URL
https://www.thieme-connect.com/products/ejournals/journal/10.1055/s-00029029