Approach to a child with pediatric inflammatory multisystem syndrome with COVID-19 recommendations by the Polish pediatric society expert group and the national consultant in the field of pediatrics

Pediatric inflammatory multisystem syndrome associated with COVID-19 (PIMS) is a new entity, occurring in children and young adults, associated with the SARS-CoV-2 infection. The first cases of PIMS were found in Poland in May 2020. Since October 2020, a significant increase in the incidence of this new disease has been observed in Poland, which reflects the increased incidence of COVID-19 in adults. PIMS development results from dysregulation of the immune system occurring after 2-4 weeks after the SARS-CoV-2 in-fection. Diagnosis is based on a set of clinical features (including fever and features of mul-tiple organ damage) and laboratory abnormalities, with the exclusion of other causes. Most common complications involve cardiovascular system: myocarditis with decreased left ven-tricular ejection fraction, shock and/or coronary artery aneurysms. Mortality is around 2%. Appropriate management, including vital functions support and immunomodulating treat-ment, allows for a quick recovery of the vast majority of patients. The following document is a proposal for diagnostic and therapeutic management of children with suspected PIMS in Poland. Copyright © 2020, Wydawnictwo Czelej Sp. z o.o.. All rights reserved.

Anakinra in treatment of pediatric inflammatory multisystem syndrome temporally associated with SARS-COV2 infection (PIMS-TS) with cardiac involvement

Background and Aim: PIMS-TS often affects the cardiovascular sys-tem resulting in myocarditis and coronary artery abnormalities (CAA). Immunosuppressive therapy is the primary treatment of PIMS-TS;however, controversies on the best regimen remain. The use of anakinra as a second-line treatment in children with cardiac involvement is often proposed lately. This prospective observational study aimed to determine the incidence of cardiac involvement in PIMS-TS and to evaluate the effectiveness and safety of anakinra in its treatment Methods: From July 2020 till December 2021, we have treated 22 children with PIMS-TS (12 boys, 10 girls;aged 0,3-15,75y (median-4y). Echocardiography assessing coronary arteries and systolic function was performed at admission, during the hospitalization, at discharge and 6-8 weeks after the onset. Result(s): Fourteen(63%) of the patients had coronary artery dilata-tion (z-score: 2,1-11,8;median:2,9), 6(27%) deterioration of sys-tolic function, 5(22%) both, 20(90%) had elevated NTproBNP. Only in 2 children (9%) there was no cardiac involvement;in 3(14%) the only cardiac sign was elevated NTproBNP. Two children required admission to ICU. In the first line immuno-suppressive treatment, we administered intravenous immunoglo-bulins (IVIG) in dose 2g/kg in all patients-of which in 16 as a monotherapy, in 6 together with glucocorticosteroids (GCS) because of their severe condition. Seven patients (32%) recovered after a single IVIG infusion, 3(14%) after repeated IVIG infusions. In this subgroup all CAA normalized or got significantly smaller with the change in the median z-score from 2,8 to 1,3. In 10 (45%) patients with cardiac involvment and insufficient response (4 with previous IVIG treatment, 6 with previous IVIG+GCS treatment) we administered anakinra obtaining clinical, laboratory and echo-cardiographic improvement in all of the patients (good systolic function and normalized or significantly smaller CAA: from z-score median = 2,8 (range: 2,1-11,8) to z-score median = 1,9 (range:0-3,2)), with no side effects. The median time to introduce anakinra (for median 9 days treatment) was 4 days after the first-line treatment. In 2 patients with suboptimal effect of first-line IVIG monotherapy, but no cardiac involvement, GCS as the second-line treatment were used. Median time of hospitalization was 18 days Conclusion(s): Cardiac involvement is common in PIMS-TS. Anakinra seems to be effective and safe in its treatment.

Approach to a child with pediatric inflammatory multisystem syndrome with covid-19 recommendations by the Polish pediatric society expert group update february 2021

Pediatric inflammatory multisystem syndrome associated with COVID-19 (PIMS) is a new entity, occurring in children and young adults, associated with the SARS-CoV-2 infection. The first cases of PIMS were found in Poland in May 2020. Since October 2020, a signi-ficant increase in this new disease incidence has been observed in Poland, reflecting the increased incidence of COVID-19 in the pediatric population. PIMS development results from dysregulation of the immune system occurring after ca. 4 weeks after the SARS-CoV-2 infection. Diagnosis is based on criteria: a set of clinical features (including fever and features of multiple organ damage) and elevated inflammatory markers, excluding other cau-ses. The most common complications involve the cardiovascular system: heart damage with decreased left ventricular ejection fraction, shock, and coronary artery abnormalities. Mortality is around 2%. Appropriate management, including vital functions support and immunomodulating treatment, allows for a quick recovery of the vast majority of patients. The following document is a guideline for the diagnostic and therapeutic management of children with suspected PIMS in Poland. © 2021, Wydawnictwo Czelej Sp. z o.o.. All rights reserved.

Approach to a child with Multisystem Inflammatory Syndrome associated with COVID-19. Recommendations by the Polish Paediatric Society Expert Group. Update - February 2021

Multisystem Inflammatory Syndrome in Children (MIS-C) is a new clinical entity occurring in children and young adults, which is associated with the SARS-CoV-2 infection. The first cases of MIS-C were diagnosed in Poland in May 2020. Since October 2020, a significant increase in the incidence of this new disease has been observed in Poland, reflecting the increased incidence of COVID-19 in the paediatric population. MIS-C develops as a result of dysregulation of the immune system occurring 4 weeks after the SARS-CoV-2 infection. Diagnosis is based on the following criteria: a set of clinical features (including fever and signs of multiple organ damage) and elevated inflammatory markers, with exclusion of other causes. The most common complications involve the cardiovascular system: acute myocardial damage with reduced left ventricular ejection fraction, shock, and coronary artery abnormalities and arrhythmias. Mortality in Western Europe and the United States is around 1-2%. Appropriate management, including vital function support and immunomodulatory treatment, allows for a quick recovery in the vast majority of patients. This document is an updated guideline for the diagnostic and therapeutic management of children with suspected MIS-C in Poland. The most important changes concern treatment, steroid therapy, and antiplatelet therapy in particular.