tetano
Editor, Senior Moderator
J Pediatr (Rio J)
. 2020 Nov 9;S0021-7557(20)30225-4.
doi: 10.1016/j.jped.2020.10.008. Online ahead of print.
Multisystem inflammatory syndrome in children (MIS-C) during SARS-CoV-2 pandemic in Brazil: a multicenter, prospective cohort study
Fernanda Lima-Setta[SUP] 1 [/SUP], Maria Clara de Magalh?es-Barbosa[SUP] 2 [/SUP], Gustavo Rodrigues-Santos[SUP] 2 [/SUP], Elaine Augusta das Neves Figueiredo[SUP] 3 [/SUP], Melissa de Lorena Jacques[SUP] 4 [/SUP], Raquel de Seixas Zeitel[SUP] 5 [/SUP], Roberto Sapolnik[SUP] 6 [/SUP], Cibelle Teixeira da Siva Borges[SUP] 7 [/SUP], Vanessa Soares Lanziotti[SUP] 8 [/SUP], Roberta Esteves Vieira de Castro[SUP] 5 [/SUP], Ana Paula Novaes Bellinat[SUP] 9 [/SUP], Thiago Peres da Silva[SUP] 10 [/SUP], Felipe Rezende Caino de Oliveira[SUP] 11 [/SUP], B?rbara Carvalho Santos Dos Reis[SUP] 12 [/SUP], Nat?lia Almeida de Arnaldo Silva Rodriguez Castro[SUP] 13 [/SUP], Jo?o Henrique Garcia Cobas Macedo[SUP] 14 [/SUP], Ana Carolina Cabral Pinheiro Scarlato[SUP] 15 [/SUP], Paula Marins Riveiro[SUP] 16 [/SUP], Isabele Coelho Fonseca da Mota[SUP] 17 [/SUP], Vivian Botelho Lorenzo[SUP] 18 [/SUP], Natalia Martins Lima de Lucena[SUP] 19 [/SUP], Zina Maria Almeida de Azevedo[SUP] 20 [/SUP], Antonio Jos? L A Cunha[SUP] 21 [/SUP], Arnaldo Prata-Barbosa[SUP] 22 [/SUP], Brazilian Research Network in Pediatric Intensive Care (BRnet-PIC)
Affiliations
Abstract
Objective: To describe the clinical, laboratory, and radiological characteristics, as well as the outcomes of children with MIS-C.
Method: Multicenter, prospective cohort study, conducted in 17 pediatric intensive care units in five states in Brazil, from March to July 2020. Patients from 1 month to 19 years who met the MIS-C diagnostic criteria were included consecutively.
Results: Fifty-six patients were included, with the following conditions: Kawasaki-like disease (n = 26), incomplete Kawasaki disease (n = 16), acute cardiac dysfunction (n = 10), toxic shock syndrome (n = 3), and macrophage activation syndrome (n = 1). Median age was 6.2 years (IQR 2.4-10.3), 70% were boys, 59% were non-whites, 20% had comorbidities, 48% reported a contact with COVID-19 cases, and 55% had a recent SARS-CoV-2 infection confirmed by RT-PCR and/or serology. Gastrointestinal symptoms were present in 71%, shock symptoms in 59%, and severe respiratory symptoms in less than 20%. d-Dimer was increased in 80% and cardiac dysfunction markers in more than 75%. Treatment included immunoglobulin (89%); corticosteroids, antibiotics, and enoxaparin in about 50%; and oseltamivir and antifungal therapy in less than 10%. Only 11% needed invasive mechanical ventilation, with a median duration of five days (IQR 5-6.5). The median length of PICU stay was six days (IQR 5-11), and one death occurred (1.8%).
Conclusions: Most characteristics of the present MIS-C patients were similar to that of other cohorts. The present results may contribute to a broader understanding of SARS-CoV-2 infection in children and its short-term consequences. Long-term multidisciplinary follow-up is needed, since it is not known whether these patients will have chronic cardiac impairment or other sequelae.
Keywords: COVID-19; Children; Coronavirus; MIS-C; Multisystem inflammatory syndrome in children; SARS-CoV-2.
. 2020 Nov 9;S0021-7557(20)30225-4.
doi: 10.1016/j.jped.2020.10.008. Online ahead of print.
Multisystem inflammatory syndrome in children (MIS-C) during SARS-CoV-2 pandemic in Brazil: a multicenter, prospective cohort study
Fernanda Lima-Setta[SUP] 1 [/SUP], Maria Clara de Magalh?es-Barbosa[SUP] 2 [/SUP], Gustavo Rodrigues-Santos[SUP] 2 [/SUP], Elaine Augusta das Neves Figueiredo[SUP] 3 [/SUP], Melissa de Lorena Jacques[SUP] 4 [/SUP], Raquel de Seixas Zeitel[SUP] 5 [/SUP], Roberto Sapolnik[SUP] 6 [/SUP], Cibelle Teixeira da Siva Borges[SUP] 7 [/SUP], Vanessa Soares Lanziotti[SUP] 8 [/SUP], Roberta Esteves Vieira de Castro[SUP] 5 [/SUP], Ana Paula Novaes Bellinat[SUP] 9 [/SUP], Thiago Peres da Silva[SUP] 10 [/SUP], Felipe Rezende Caino de Oliveira[SUP] 11 [/SUP], B?rbara Carvalho Santos Dos Reis[SUP] 12 [/SUP], Nat?lia Almeida de Arnaldo Silva Rodriguez Castro[SUP] 13 [/SUP], Jo?o Henrique Garcia Cobas Macedo[SUP] 14 [/SUP], Ana Carolina Cabral Pinheiro Scarlato[SUP] 15 [/SUP], Paula Marins Riveiro[SUP] 16 [/SUP], Isabele Coelho Fonseca da Mota[SUP] 17 [/SUP], Vivian Botelho Lorenzo[SUP] 18 [/SUP], Natalia Martins Lima de Lucena[SUP] 19 [/SUP], Zina Maria Almeida de Azevedo[SUP] 20 [/SUP], Antonio Jos? L A Cunha[SUP] 21 [/SUP], Arnaldo Prata-Barbosa[SUP] 22 [/SUP], Brazilian Research Network in Pediatric Intensive Care (BRnet-PIC)
Affiliations
- PMID: 33186512
- PMCID: PMC7649656
- DOI: 10.1016/j.jped.2020.10.008
Abstract
Objective: To describe the clinical, laboratory, and radiological characteristics, as well as the outcomes of children with MIS-C.
Method: Multicenter, prospective cohort study, conducted in 17 pediatric intensive care units in five states in Brazil, from March to July 2020. Patients from 1 month to 19 years who met the MIS-C diagnostic criteria were included consecutively.
Results: Fifty-six patients were included, with the following conditions: Kawasaki-like disease (n = 26), incomplete Kawasaki disease (n = 16), acute cardiac dysfunction (n = 10), toxic shock syndrome (n = 3), and macrophage activation syndrome (n = 1). Median age was 6.2 years (IQR 2.4-10.3), 70% were boys, 59% were non-whites, 20% had comorbidities, 48% reported a contact with COVID-19 cases, and 55% had a recent SARS-CoV-2 infection confirmed by RT-PCR and/or serology. Gastrointestinal symptoms were present in 71%, shock symptoms in 59%, and severe respiratory symptoms in less than 20%. d-Dimer was increased in 80% and cardiac dysfunction markers in more than 75%. Treatment included immunoglobulin (89%); corticosteroids, antibiotics, and enoxaparin in about 50%; and oseltamivir and antifungal therapy in less than 10%. Only 11% needed invasive mechanical ventilation, with a median duration of five days (IQR 5-6.5). The median length of PICU stay was six days (IQR 5-11), and one death occurred (1.8%).
Conclusions: Most characteristics of the present MIS-C patients were similar to that of other cohorts. The present results may contribute to a broader understanding of SARS-CoV-2 infection in children and its short-term consequences. Long-term multidisciplinary follow-up is needed, since it is not known whether these patients will have chronic cardiac impairment or other sequelae.
Keywords: COVID-19; Children; Coronavirus; MIS-C; Multisystem inflammatory syndrome in children; SARS-CoV-2.