tetano
Editor, Senior Moderator
Glob Pediatr Health
. 2021 Jan 27;8:2333794X21990339.
doi: 10.1177/2333794X21990339. eCollection 2021.
The "Golden Hours" Algorithm For the Management of the Multisystem Inflammatory Syndrome in Children (MIS-C)
Sanaa Mahmoud[SUP] 1 2 3 [/SUP], Eman M Fouda[SUP] 2 3 [/SUP], Alyaa Kotby[SUP] 2 3 [/SUP], Hanan M Ibrahim[SUP] 2 3 [/SUP], Mervat Gamal[SUP] 2 [/SUP], Yasmin G El Gendy[SUP] 2 [/SUP], Eman Ahmed Zaky[SUP] 2 [/SUP], Nermine H Amr[SUP] 2 [/SUP], Dalia H El-Ghoneimy[SUP] 2 3 [/SUP], Asmaa Aa Alsharkawy[SUP] 2 [/SUP], Ashraf Omar[SUP] 2 [/SUP], Mahmoud El-Meteini[SUP] 2 [/SUP], Mostafa Elhodhod[SUP] 2 3 [/SUP]
Affiliations
Abstract
The global concern of increasing number of children presenting with multisystem inflammatory syndrome in children (MIS-C) related to the coronavirus disease (COVID-19) has escalated the need for a case-oriented clinical approach that provides timely diagnosis and management. The aim of this study is to share our experience in managing 64 MIS-C patients of North African ethnicity guided by a risk-based algorithm. Sixty-four patients met the inclusion criteria, 19 (30%) patients were categorized as mild and moderate risk groups and cared for in an isolation ward and 45 patients who belonged to the high-risk group (70%) were admitted to the pediatric intensive care unit (PICU). Positive laboratory evidence of COVID-19 was found in 62 patients. Fever and dysfunction in 2 or more organs were confirmed in all cases (100%). Fifty patients (78%) presented with gastrointestinal symptoms, meanwhile only 10 patients (16%) had respiratory manifestations. Cardiac involvement was reported in 55 (86%) cases; hypotension and shock were found in 45 patients (70%) therein circulatory support and mechanical ventilations were needed for 45 and 13 patients respectively. Intravenous immunoglobulins (IVIG) were used for all cases and methylprednisolone was used in 60 patients (94%). Fifty-eight (91%) patients were discharged home after an average of 9 days of hospitalization. The mortality rate was 9% (6 patients). Conclusion. A single Egyptian center experience in the management of MIS-C patients guided by a proposed bed side algorithm is described. The algorithm proved to be a helpful tool for first-line responders, and helped initiate early treatment with IVIG.
Keywords: COVID-19; IVIG; Kawasaki disease; algorithm; pediatric MIS-C.
. 2021 Jan 27;8:2333794X21990339.
doi: 10.1177/2333794X21990339. eCollection 2021.
The "Golden Hours" Algorithm For the Management of the Multisystem Inflammatory Syndrome in Children (MIS-C)
Sanaa Mahmoud[SUP] 1 2 3 [/SUP], Eman M Fouda[SUP] 2 3 [/SUP], Alyaa Kotby[SUP] 2 3 [/SUP], Hanan M Ibrahim[SUP] 2 3 [/SUP], Mervat Gamal[SUP] 2 [/SUP], Yasmin G El Gendy[SUP] 2 [/SUP], Eman Ahmed Zaky[SUP] 2 [/SUP], Nermine H Amr[SUP] 2 [/SUP], Dalia H El-Ghoneimy[SUP] 2 3 [/SUP], Asmaa Aa Alsharkawy[SUP] 2 [/SUP], Ashraf Omar[SUP] 2 [/SUP], Mahmoud El-Meteini[SUP] 2 [/SUP], Mostafa Elhodhod[SUP] 2 3 [/SUP]
Affiliations
- PMID: 33614843
- PMCID: PMC7868488
- DOI: 10.1177/2333794X21990339
Abstract
The global concern of increasing number of children presenting with multisystem inflammatory syndrome in children (MIS-C) related to the coronavirus disease (COVID-19) has escalated the need for a case-oriented clinical approach that provides timely diagnosis and management. The aim of this study is to share our experience in managing 64 MIS-C patients of North African ethnicity guided by a risk-based algorithm. Sixty-four patients met the inclusion criteria, 19 (30%) patients were categorized as mild and moderate risk groups and cared for in an isolation ward and 45 patients who belonged to the high-risk group (70%) were admitted to the pediatric intensive care unit (PICU). Positive laboratory evidence of COVID-19 was found in 62 patients. Fever and dysfunction in 2 or more organs were confirmed in all cases (100%). Fifty patients (78%) presented with gastrointestinal symptoms, meanwhile only 10 patients (16%) had respiratory manifestations. Cardiac involvement was reported in 55 (86%) cases; hypotension and shock were found in 45 patients (70%) therein circulatory support and mechanical ventilations were needed for 45 and 13 patients respectively. Intravenous immunoglobulins (IVIG) were used for all cases and methylprednisolone was used in 60 patients (94%). Fifty-eight (91%) patients were discharged home after an average of 9 days of hospitalization. The mortality rate was 9% (6 patients). Conclusion. A single Egyptian center experience in the management of MIS-C patients guided by a proposed bed side algorithm is described. The algorithm proved to be a helpful tool for first-line responders, and helped initiate early treatment with IVIG.
Keywords: COVID-19; IVIG; Kawasaki disease; algorithm; pediatric MIS-C.