ABSTRACT
BACKGROUND AND AIM: The multisystem inflammatory syndrome in children (MIS-C) is a new entity and needs data to study its evolution. To describe the clinicolaboratory profile, intensive care needs, and outcome of MIS-C during the first and second waves. METHOD(S): Retrospective analysis of 122 children with MIS-C admitted to Pediatric emergency and PICU of a tertiary-teaching hospital during first and second wave of Covid-19. RESULT(S): Median (IQR) age was 7 (4-10) years with 67% boys. Common manifestations included fever (99%), abdominal symptoms (81%), rash (66%), conjunctival injection (65%), oral mucosa and respiratory involvement (43% each). Elevated CRP (97%), D-dimer (89%), procalcitonin (80%), IL-6 (78%), ferritin (56%), NT-pro- BNP (84%), and positive SARS-CoV-2 antibody (81%) were common laboratory abnormalities. Cardiovascular manifestations included myocardial dysfunction (55%), shock (48%), and coronary artery changes (10%). The treatment included intensive care support (57%), non-invasive (33%) and invasive (18%) ventilation, vasoactive drugs (47%), IVIG (83%), steroids (85%), and aspirin (87%). Mortality was 5% (n=6). Duration of hospital stay was 5 (3-8) days. During second wave, significantly higher proportion had positive SARS-CoV-2 antibody, contact with COVID-19 case, and oral mucosal changes;lower markers of inflammation (CRP, procalcitonin, ferritin, and IL-6);lower rates of shock, myocardial dysfunction, and coronary artery changes;lesser need of PICU, vasoactive drugs, and IVIG;and shorter hospital stay. CONCLUSION(S): MIS-C is febrile multisystemic disease characterized by hyperinflammation, cardiovascular involvement, relationship to SARS-CoV-2, and good outcome with immunomodulation and intensive care. During the second wave, the severity of illness, degree of inflammation, and intensive care needs was lesser.
ABSTRACT
The 2019-novel coronavirus predominantly affects the respiratory system with manifestations ranging from upper respiratory symptoms to full blown acute respiratory distress syndrome (ARDS). It is important to recognize the risk factors, categorize severity and provide early treatment. Use of high flow devices and non-invasive ventilation has been discouraged due to high chances of aerosol generation. Early intubation and mechanical ventilation areessential to prevent complications and worsening, especially in resource-limited settings with very few centers having expertise to manage critical cases. Hydrophobic viral filter in the ventilator circuit minimizes chances of transmission of virus. Strategies to manage ARDS in COVID-19 include low tidal volume ventilation with liberal sedation-analgesia. At the same time, prevention of transmission of the virus to healthcare workers is extremely important in the intensive care setting dealing with severe cases and requiring procedures generating aerosol. We, herein, provide guidance on non-invasive respiratory support, intubation and management of ARDS in a child with COVID-19.