Management of Shock in Multisystem Infammatory Syndrome Associated with COVID-19 in Children (MIS-C)

Severe infammatory state shock is commonly encountered in critically ill patients due to multisystem infammatory syndrome associated with COVID-19 (MIS-C) and is accompanied with high mortality. All four types of shock (i.e., distributive, cardiogenic, obstructive, and hypovolemic) have been observed in patients with MIS-C. Hyper-infammatory immune response with cytokine release syndrome leads to loss of vasomotor tone and higher rates of mortality. In vasodilatory shock, norepinephrine is considered as the preferred vasopressor agent and as the second line of treatment, vasopressin or epinephrine could be added. In acute cardiac injury followed by ischemia, myocarditis or cardiomyopathy, inotropic agents such as milrinone, dobutamine and epinephrine may be contemplated and in patients with hypotensive cardiogenic shock, norepinephrine is administered as the first-line vasopressor. Pneumothorax, pneumomediastinum and rarely, cardiac tamponade are etiologies of obstructive shock in COVID-19. Hypovolemia may be present due to poor oral intake, high-grade fever, diarrhea and bleeding induced by anticoagulant medications. In pediatric patients presenting with COVID-19 and shock, we suggest parenteral fuid therapy with crystalloid solutions, 10 - 20 mL/kg up to 40 - 60 mL/ kg bolus infusion in settings with pediatric intensive care unit (PICU) availability. However, in settings with inadequate pediatric critical care services, it is recommended to administer bolus fuids (10 - 20 mL/kg per bolus, up to 40 mL/kg) only in hypotensive patient. Evidences of improved outcomes with early administration of vasopressors are signifed recently. In conclusion, shock associated with COVID-19 seems to have better outcomes in children compared with adults.

Spontaneous Pneumothorax in a Child with COVID-19

Introduction: SARS-CoV2 (COVID-19) is a serious and global infection that has spread to numerous countries, including Iran. Pneumothorax may occur in cases of COVID-19 as a consequence of lung parenchymal damage, which can disrupt the healing process and increase mortality. Case Presentation: This manuscript describes the case of a 2-year-old boy with hyper IgM syndrome and COVID-19 infection. The patient developed spontaneous pneumothorax and recovered without chest tube by supportive care and was discharged in good general condition after the completion of the antibiotic course and cessation of fever. Conclusions: The severity, prognosis, and best treatment for spontaneous pneumothorax in COVID-19 infection, especially in children, remain nebulous. It is recommended that conservative treatment be performed if the patient has stable vital signs and no severe respiratory failure. However, this requires more detailed clinical evaluations. © 2021, Author(s).

A Child with Multiple Inflammatory Syndrome in Children, Stroke and Cardiac Insufficiency

Multiple inflammatory syndrome in children (MIS-C) is a multisystem inflammatory disease following COVID-19 in children. This disease occurs a few weeks after COVID-19. A child with this condition develops a cytokine release cascade that results in organ damage. The involved organs include the heart, lungs, brain, gastrointestinal tract, and central nervous system. Fever is present in all patients and Kawasaki-like symptoms are one of the common features in these children. In this article, we introduce a child with MIS-C who has skin, gastrointestinal, neurological, and renal symptoms and has been hospitalized in the PICU.