ABSTRACT
Introduction: Studies have shown the differential impact of the second surge of acute Covid-19 infection, across age, clinical outcome and ethnicity. How these factors impact the clinical characteristics and outcome of multisystem inflammatory syndrome in children (MIS-C) is largely unknown. Objectives: This hospital based comparative study was undertaken to analyse the clinical characteristics and outcomes of patients admitted with MIS-C during the two waves of Covid-19 infection in a tertiary care teaching hospital in South India. Method: Patients admitted between September 2020 and October 2021 with MIS-C were included in this study. Patient demographics, laboratory values and treatment details were compared between the two surges of COVID 19 related MIS-C. Results: Sixty-five children were admitted with MIS-C in the first wave and 73 in the second wave. More children were referred with a diagnosis of MIS-C in the second wave (p=0.001). There was no significant difference in the mean age or malefemale ratio between the two waves. A significantly higher proportion of children in the second wave had cervical lymphadenitis (p=0.02). Need for intensive care unit (ICU) admission (p<0.001), shock (p<0.001), respiratory support (p<0.001) and multiorgan involvement (p<0.001) were significantly lower in the second wave.Conclusions: A significantly higher proportion of children with MIS-C in the second wave of Covid-19 infection had cervical lymphadenitis. The need for ICU admission, shock, respiratory support and multi-organ involvement were significantly lower in children with MIS-C in the second wave of Covid-19 infection © Open Access Article published under the Creative Commons Attribution CC-BY License
ABSTRACT
Objective This article determines the occurrence and variables associated with pulse methylprednisolone treatment failure in children with coronavirus disease 2019 (COVID-19)-related multisystem inflammatory syndrome in children (MIS-C). Methods This prospective observational study was undertaken at a tertiary care teaching hospital in Kerala, India. Children admitted with COVID-19-related MIS-C who were treated with pulse methylprednisolone as first-line therapy were included in the study. Depending on the response to the treatment, they were divided into two groups. The clinical, laboratory parameters, and follow-up findings at 3 months were compared between the two groups Results Seventy-six patients were admitted with MIS-C during the study period. Sixty received pulse methylprednisolone as the first-line therapy. Of the 60 patients who received pulse methylprednisolone, 50 responded to treatment, while 10 required repeat immunomodulation. Need for noninvasive or invasive ventilation (relative risk [RR]: 13.14, 95% confidence interval [CI]: 3.147-54.88), six or more organ involvement (RR: 4.667, 95% CI: 1.349-16.149), thrombocytopenia (RR: 6.43, 95% CI: 0.87-47.6, p 0.003), and abnormal chest X-ray findings at admission (RR: 4.5, 95% CI: 1.46-13.8), were found to be associated with increased risk of treatment failure with pulse methylprednisolone therapy. Note that 88% of patients with coronary artery involvement showed resolution at 3-month follow-up. Conclusion More than 80% of children with MIS-C can be treated successfully with corticosteroids. The need for ventilator support, abnormal chest X-ray findings, and thrombocytopenia at admission were found to be factors associated with pulse methylprednisolone treatment failure.
ABSTRACT
Objective: To study the clinical profile and outcome of children with MIS-C treated with methylprednisolone pulse therapy and/or intravenous immunoglobulin (IVIG). Method: This prospective observational study included children satisfying CDC MIS-C criteria admitted from September to November, 2020. Primary outcome was persistence of fever beyond 36 hours after start of immunomodulation therapy. Secondary outcomes included duration of ICU stay, mortality, need for repeat immunomodulation, time to normalization of CRP and persistence of coronary abnormalities at 2 weeks. Results: Study population included 32 patients with MIS-C with median (IQR) age of 7.5 (5–9.5) years. The proportion of children with gastrointestinal symptoms was 27 (84%), cardiac was 29 (91%) and coronary artery dilatation was 11 (34%). Pulse methylprednisolone and intravenous immunoglobulin were used as first line therapy in 26 (81%), and 6 (19%) patients, respec-tively. Treatment failure was observed in 2/26 patients in methylprednisolone group and 2/6 patients in IVIG group. C-reactive protein levels less than 60mg/L by day 3 was seen in 17(74%) in methylprednisolone group and 2 (25%) in IVIG group (P=0.014). There was no mortality. At 2 weeks follow-up coronary artery dilatation persisted in 4 in methylprednisolone group and 1 in IVIG group. Conclusion: In patients with SARS-CoV-2 related MIS-C, methylprednisolone pulse therapy was associated with favorable short-term outcomes. © 2021, Indian Academy of Pediatrics.
ABSTRACT
BACKGROUND: Multi system inflammatory syndrome in children (MIS-C) is a rare, but life-threatening complication of SARS-CoV-2 infection. OBJECTIVES: To study the clinical profile and outcome of children with MIS-C treated with methylprednisolone pulse therapy and /or IVIG. STUDY DESIGN: Observational study. PARTICIPANTS: Children satisfying CDC MIS-C criteria admitted during the study period. OUTCOME MEASURES: Primary outcome was persistence of fever beyond 36 hours after start of immunomodulation therapy. Secondary outcomes included duration of ICU stay, mortality, need for repeat immunomodulation, time to normalization of CRP and persistence of coronary abnormalities at 2 weeks. RESULTS: Study population included 32 patients with MIS-C with median (IQR) age of 7.5 (5-9.5) years. The proportion of children with gastrointestinal symptoms was 27 (84%), cardiac was 29 (91%) and coronary artery dilatation was 11 (34%). Pulse methylprednisolone and intravenous immunoglobulin were used as first line therapy in 26 (81%), and 6 (19%) patients, respectively. Treatment failure was observed in 2/26 patients in methylprednisolone group and 2/6 patients in IVIG group. C-reactive protein levels less than 60mg/L by day 3 was seen in 17(74%) in methylprednisolone group and 2 (25%) in IVIG group (P=0.014). There was no mortality. At 2 weeks follow-up coronary artery dilatation persisted in 4 in methylprednisolone group and 1 in IVIG group. CONCLUSIONS: In patients with SARS-CoV-2 related MIS-C, methylprednisolone pulse therapy was associated with favorable short-term outcomes.