Pediatric Multisystemic Inflammatory Syndrome Temporarily associated with COVID-19: clinical characteristics and management in a Pediatric Critical Care Unit

Abstract

In April 2020, the pediatric multisystem inflammatory syndrome temporarily associated with COVID-19 (MIS-C) was described for the first time. MIS-C could have a severe course and may require critical care support.

Objective: To describe the clinical, laboratory, and management characteristics of hospitalized children who meet MIS-C criteria with severe presentation in a pediatric critical patient unit.

Patients and Method: Descriptive prospective study of children with severe MIS-C managed by treatment phases with immunoglobulin and methylprednisolone, according to their clinical response. Epidemiological, clinical, laboratory and imaging data were obtained. Phenotypes were classified into Kawasaki and not Kawasaki, comparing their findings.

Results: 20 patients were analyzed, the median age was 6 years, 60% were female, and 40% presented comorbidity. SARS-CoV-2 was detected in 90% of the patients. They presented fever as the first symptom, followed by brief and early gastrointestinal symptoms (70%). 75% presented the Kawasaki phenotype. They evolved with lymphopenia, hypoalbuminemia, coagulation alterations, and elevated systemic and cardiac inflammatory parameters. 80% of the cases presented echocardiographic alterations and 90% shock that required critical care support. All the patients had a short and favorable evolution. All patients responded to the established therapy, but 40% required a second phase of treatment. There were no differences when comparing phenotypes. No deaths were reported.

Conclusion: MIS-C is a new childhood disease whose presentation could be life-threatening. It requires early suspicion, immunomodulatory management, critical care support, and a multidisciplinary approach to obtain the best results and optimize its prognosis.