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J Pediatr Intensive Care 2022; 11(02): 124-129
DOI: 10.1055/s-0040-1721456
Original Article

Critical Care Course of Pediatric Inflammatory Multisystem Syndrome Temporally Associated with SARS-CoV-2 and Response to Immunomodulation

Nicholas Richens‡   *
1   Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
,
Hari Krishnan Kanthimathinathan  ‡   *
1   Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
2   Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, United Kingdom
,
Sanket Sontakke 
1   Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
,
Ashish Chikermane 
3   Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
,
Deepthi Jyothish
4   Department of Paediatrics, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
,
Scott Hackett
5   Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
,
Steven B. Welch 
5   Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham, Birmingham, United Kingdom
,
Eslam Al-Abadi 
6   Childhood Arthritis and Rheumatic Diseases Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
,
Heather P. Duncan 
1   Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
,
Alex G. Richter 
7   Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, United Kingdom
,
Barnaby R. Scholefield 
1   Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, United Kingdom
8   Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, United Kingdom
› Author Affiliations Funding None.
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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.

Keywords

coronavirus disease 2019 - Kawasaki disease - inflammation - toxic shock syndrome - SARS-CoV-2

* Authors contributed equally to this study.




Publication History

Received: 27 July 2020

Accepted: 31 October 2020

Article published online:
04 December 2020

© 2020. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

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