RESUMO
BACKGROUND: The clinical presentation and severity of Multisystem Inflammatory Syndrome in Children associated with COVID-19 (MIS-C) is widespread and presents a very low mortality rate in high-income countries. This research describes the clinical characteristics of MIS-C in critically ill children in middle-income countries and the factors associated with the rate of mortality and patients with critical outcomes. METHODS: An observational cohort study was conducted in 14 pediatric intensive care units (PICUs) in Colombia between April 01, 2020, and January 31, 2021. Patient age ranged between one month and 18 years, and each patient met the requirements set forth by the World Health Organization (WHO) for MIS-C. RESULTS: There were seventy-eight children in this study. The median age was seven years (IQR 1-11), 18 % (14/78) were under one year old, and 56 % were male. 35 % of patients (29/78) were obese or overweight. The PICU stay per individual was six days (IQR 4-7), and 100 % had a fever upon arrival to the clinic lasting at least five days (IQR 3.7-6). 70 % (55/78) of patients had diarrhea, and 87 % (68/78) had shock or systolic myocardial dysfunction (78 %). Coronary aneurysms were found in 35 % (27/78) of cases, and pericardial effusion was found in 36 %. When compared to existing data in high-income countries, there was a higher mortality rate observed (9 % vs. 1.8 %; p=0.001). When assessing the group of patients that did not survive, a higher frequency of ferritin levels was found, above 500 ngr/mL (100 % vs. 45 %; p=0.012), as well as more cardiovascular complications (100 % vs. 54 %; p = 0.019) when compared to the group that survived. The main treatments received were immunoglobulin (91 %), vasoactive support (76 %), steroids (70.5 %) and antiplatelets (44 %). CONCLUSIONS: Multisystem Inflammatory Syndrome in Children due to SARS-CoV-2 in critically ill children living in a middle-income country has some clinical, laboratory, and echocardiographic characteristics similar to those described in high-income countries. The observed inflammatory response and cardiovascular involvement were conditions that, added to the later presentation, may explain the higher mortality seen in these children.
Assuntos
COVID-19 , COVID-19/complicações , Criança , Pré-Escolar , Estado Terminal , Humanos , Lactente , Masculino , SARS-CoV-2 , Síndrome de Resposta Inflamatória SistêmicaRESUMO
Contrast-induced encephalopathy (CIE) is a well-known but rare complication following contrast media administration. Its nonspecific clinical manifestations hinder diagnosis, particularly in the pediatric population. The majority of cases are reversible, with clinical improvement and resolution of signs noted on diagnostic imaging. Here, we report the case of a 2-month-old patient with a history of complex cardiovascular disease who presented with a single episode of seizure after undergoing cardiac catheterization with nonionic iodinated contrast media. CIE is diagnosed based on the signs and symptoms exhibited by the patient and the findings on plain head computed tomography (CT) scan. Subsequently, the absence of neurological symptoms and disappearance of the imaging alterations on a control CT are documented.
RESUMO
Resumen La oxigenación con membrana extracorpórea (ECMO), es una alternativa terapéutica útil en el manejo de la falla respiratoria refractaria en la edad pediátrica. La infección por virus sincitial respiratorio es una patología prevalente en nuestra ciudad con una carga de la enfermedad que supone el 75% de las hospitalizaciones en menores de 2 años diagnosticados con bronquiolitis. Un índice de oxigenación mayor a 40 predice una mortalidad mayor del 80% en estos pacientes, asimismo, se ha encontrado que un pH menor de 7.29 es un factor de riesgo independiente para la mortalidad en el mismo grupo. La ECMO es una terapia que desde el año 1985 ha mostrado tener una sobrevida del 53% en este grupo, llegando a niveles del 63% en los últimos años, particularmente, si la etiología es el virus sincitial respiratorio. Se reportan dos casos de pacientes lactantes menores con falla respiratoria refractaria en quienes se decidió iniciar la ECMO logrando la sobrevida de ambos.
Abstract Extracorporeal membrane oxygenation (ECMO) is a useful alternative therapy when managing refractory respiratory failure in pediatric patients. An infection caused by respiratory syncytial virus is a prevalent condition in our city, with a disease burden that accounts for 75% of hospital admissions in children under to years of age who have been diagnosed of bronchiolitis. An oxygenation index above 40 predicts a mortality of over 80% for these patients; likewise, it has been found that a pH below 7.29 is an independent mortality risk factor for this same group. ECMO is a therapy that has shown survival rates of 53% in this patient group since 1985, reaching a level of 63% over recent years, particularly when the aetiology is respiratory syncytial virus. Two cases of infants with refractory respiratory failure where ECMO therapy was chosen and achieved survival of both children are reported.
