ABSTRACT
BACKGROUND AND AIM: Severe Multi Inflammatory Syndrome in Children (MISC) is known to cause high morbidity and mortality. Cardiac dysfunction is the main debilitating organ affected by MISC post COVID 19 infection and often requires the use of ECMO for survival. ECMO service is not widely available in Malaysia. We describe the use of Continuous Renal Replacement Therapy (CRRT) and Plasma Exchange (PLEX) in severe MISC our case series. METHOD(S): All paediatric patients with MISC from April 2021 to January 2022 in Paediatric High Dependency Unit Hospital Selayang, Malaysia was included. Case definition as per CDC and WHO guideline. Clinical presentation divided to Kawasaki-like, shock, undifferentiated fever-like and severe refractory MISC. Analysis includes length of stay, length of ventilation, inflammatory markers (CRP, ESR, IL-6, IL-1, IL-10), cardiac markers (Trop-I, NT-ProBNP), treatment with IVIG and steroids, CRRT, Plex, morbidity and mortality. RESULT(S): Total patients were 25 (age 1month to 17 years). Thirty six percent are school-going age (5years to less than 9 years old), Average length of ICU stay was 5 days (median). Cardiac complications include coronary dilatation (n=3), pericardial effusion (n=4), perivascular cuffing (n=7), IVS dyskinesia (n=2), poor contractility (n=3) and low ejection fraction <55% (n=6). Six required CRRT and 2 required PLEX, with age range from day 24 of life to 11 years. All patient survived with 4 required anti-failure medications upon discharge. CONCLUSION(S): MISC is a newly described disease during the COVID 19 pandemic. Our patients with severe refractory were successfully treated with IVIG, high dose steroids and CRRT and PLEX.