tetano
Editor, Senior Moderator
CJC Open
. 2020 Sep 11.
doi: 10.1016/j.cjco.2020.09.004. Online ahead of print.
Management of Multisystem Inflammatory Syndrome in Children Associated with COVID-19: A Survey from the International Kawasaki Disease Registry
Matthew D Elias[SUP] 1 [/SUP], Brian W McCrindle[SUP] 2 [/SUP], Guillermo Larios[SUP] 3 [/SUP], Nadine F Choueiter[SUP] 4 [/SUP], Nagib Dahdah[SUP] 5 [/SUP], Ashraf S Harahsheh[SUP] 6 [/SUP], Supriya Jain[SUP] 7 [/SUP], Cedric Manlhiot[SUP] 8 [/SUP], Michael A Portman[SUP] 9 [/SUP], Geetha Raghuveer[SUP] 10 [/SUP], Therese M Giglia[SUP] 1 [/SUP], Audrey Dionne[SUP] 11 [/SUP], International Kawasaki Disease Registry
Affiliations
Abstract
Background: Since April 2020, there have been numerous reports of children presenting with systemic inflammation, often in critical condition, and with evidence of recent infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This condition, since defined as the multisystem inflammatory syndrome in children (MIS-C), is assumed to be a delayed immune response to COVID-19, and there are frequently cardiac manifestations of ventricular dysfunction and/or coronary artery dilation.
Methods: We surveyed the inpatient MIS-C management approaches of the members of the International Kawasaki Disease Registry across 38 institutions and 11 countries.
Results: Among the respondents, 56% reported using immunomodulatory treatment for all MIS-C patients, regardless of presentation. Every respondent reported use of intravenous immunoglobulin (IVIG), including 53% administering IVIG in all patients. Steroids were most often used for patients with severe clinical presentation or lack of response to IVIG, and only a minority used steroids in all patients (14%). ASA was frequently used among respondents (91%), including anti-inflammatory and/or anti-platelet dosing. Respondents reported use of prophylactic anticoagulation, especially in patients at higher risk for venous thromboembolism, and therapeutic anticoagulation, particularly for patients with giant coronary artery aneurysms.
Conclusions: There is variation in management of MIS-C patients with suboptimal evidence to assess superiority of the various treatments; evidence-based gaps in knowledge should be addressed through worldwide collaboration to optimize treatment strategies.
Keywords: ASA, Acetylsalicylic acid; BNP, B-type natriuretic peptide; COVID-19, coronavirus disease 2019; Coronavirus disease 2019 (COVID-19); ECMO, extracorporeal membrane oxygenation; IKDR, International Kawasaki Disease Registry; IVIG, intravenous immunoglobulin; KD, Kawasaki disease; MIS-C, Multisystem inflammatory syndrome in children; Multisystem inflammatory syndrome in children (MIS-C); SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2; Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).
. 2020 Sep 11.
doi: 10.1016/j.cjco.2020.09.004. Online ahead of print.
Management of Multisystem Inflammatory Syndrome in Children Associated with COVID-19: A Survey from the International Kawasaki Disease Registry
Matthew D Elias[SUP] 1 [/SUP], Brian W McCrindle[SUP] 2 [/SUP], Guillermo Larios[SUP] 3 [/SUP], Nadine F Choueiter[SUP] 4 [/SUP], Nagib Dahdah[SUP] 5 [/SUP], Ashraf S Harahsheh[SUP] 6 [/SUP], Supriya Jain[SUP] 7 [/SUP], Cedric Manlhiot[SUP] 8 [/SUP], Michael A Portman[SUP] 9 [/SUP], Geetha Raghuveer[SUP] 10 [/SUP], Therese M Giglia[SUP] 1 [/SUP], Audrey Dionne[SUP] 11 [/SUP], International Kawasaki Disease Registry
Affiliations
- PMID: 32935083
- PMCID: PMC7484693
- DOI: 10.1016/j.cjco.2020.09.004
Abstract
Background: Since April 2020, there have been numerous reports of children presenting with systemic inflammation, often in critical condition, and with evidence of recent infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This condition, since defined as the multisystem inflammatory syndrome in children (MIS-C), is assumed to be a delayed immune response to COVID-19, and there are frequently cardiac manifestations of ventricular dysfunction and/or coronary artery dilation.
Methods: We surveyed the inpatient MIS-C management approaches of the members of the International Kawasaki Disease Registry across 38 institutions and 11 countries.
Results: Among the respondents, 56% reported using immunomodulatory treatment for all MIS-C patients, regardless of presentation. Every respondent reported use of intravenous immunoglobulin (IVIG), including 53% administering IVIG in all patients. Steroids were most often used for patients with severe clinical presentation or lack of response to IVIG, and only a minority used steroids in all patients (14%). ASA was frequently used among respondents (91%), including anti-inflammatory and/or anti-platelet dosing. Respondents reported use of prophylactic anticoagulation, especially in patients at higher risk for venous thromboembolism, and therapeutic anticoagulation, particularly for patients with giant coronary artery aneurysms.
Conclusions: There is variation in management of MIS-C patients with suboptimal evidence to assess superiority of the various treatments; evidence-based gaps in knowledge should be addressed through worldwide collaboration to optimize treatment strategies.
Keywords: ASA, Acetylsalicylic acid; BNP, B-type natriuretic peptide; COVID-19, coronavirus disease 2019; Coronavirus disease 2019 (COVID-19); ECMO, extracorporeal membrane oxygenation; IKDR, International Kawasaki Disease Registry; IVIG, intravenous immunoglobulin; KD, Kawasaki disease; MIS-C, Multisystem inflammatory syndrome in children; Multisystem inflammatory syndrome in children (MIS-C); SARS-CoV-2, Severe acute respiratory syndrome coronavirus 2; Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).