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1.
EuropePMC; 2020.
Preprint in English | EuropePMC | ID: ppcovidwho-323171

ABSTRACT

Background: The aim of the study was to document cardiovascular clinical findings, cardiac imaging and laboratory markers in children presenting with the novel multisystemic inflammatory syndrome associated with COVID-19. Methods: A real-time internet based survey was sent via the member mailing database for Association for European Paediatric and Congenital Cardiologists (AEPC) working groups for Cardiac Imaging and Cardiovascular Intensive Care member. Inclusion criteria was children 0-18 years admitted to hospital between March 1 and June 6, 2020 with diagnosis of an inflammatory syndrome and acute cardiovascular complications. Findings: A total of 286 children from 55 centres from 17 European countries were included. The median age was 8·4 years (IQR 3·8-12·4 years) and 67% were males. Most common cardiovascular complications were shock (40%), cardiac arrhythmias (35%), pericardial effusion (28%) and coronary artery dilatation (24%). Reduced left ventricular ejection fraction was present in 52% of patients and 93% had raised cardiac troponin (cTnT). The biochemical markers of inflammation were raised in majority of patients on admission: elevated CRP (99%), ferritin (79%), procalcitonin (96%), NT-proBNP (93%), IL-6 level (88%) and D-dimers (90%). There was a statistically significant correlation between degree of elevation in cardiac and biochemical parameters and need of intensive care support (p <0·05). Polymerase chain reaction (PCR) for SARS-CoV-2 was positive in 33·6% while IgM antibody was positive in 15·7% and IgG 43·6% cases. Only 1 death was reported· Interpretation: Cardiac involvement is common in children with multi-inflammatory syndrome associated with COVID-19 pandemic. A majority of children have significantly raised levels of NT pro-BNP, ferritin, D-dimers and cardiac troponin in addition to high CRP and procalcitonin levels. Compared to adults, mortality in children with PIMS-TS is extremely rare despite multi-system involvement, very elevated inflammatory markers and need of intensive care support.Funding Statement: There was no external funding source for this studyDeclaration of Interests: The authors declare no competing interests.Ethics Approval Statement: Local institutional approval was obtained, where required, by participating centres as collaborative anonymised data, according to the principles of the Declaration of Helsinki.

3.
Pediatr Radiol ; 51(9): 1608-1620, 2021 08.
Article in English | MEDLINE | ID: covidwho-1202740

ABSTRACT

BACKGROUND: A hyperinflammatory immune-mediated shock syndrome has been recognised in children exposed to the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), the virus that causes coronavirus disease 2019 (COVID-19). OBJECTIVE: To describe typical imaging findings in children with multisystem inflammatory syndrome associated with COVID-19. MATERIALS AND METHODS: During the first wave of the COVID-19 pandemic, imaging studies and clinical data from children treated for multisystem inflammatory syndrome were collected from multiple centres. Standardised case templates including demographic, biochemical and imaging information were completed by participating centres and reviewed by paediatric radiologists and paediatricians. RESULTS: We included 37 children (21 boys; median age 8.0 years). Polymerase chain reaction (PCR) testing was positive for SARS-CoV-2 in 15/37 (41%) children and immunoglobulins in 13/19 children (68%). Common clinical presentations were fever (100%), abdominal pain (68%), rash (54%), conjunctivitis (38%) and cough (32%). Thirty-three children (89%) showed laboratory or imaging findings of cardiac involvement. Thirty of the 37 children (81%) required admission to the intensive care unit, with good recovery in all cases. Chest radiographs demonstrated cardiomegaly in 54% and signs of pulmonary venous hypertension/congestion in 73%. The most common chest CT abnormalities were ground-glass and interstitial opacities (83%), airspace consolidation (58%), pleural effusion (58%) and bronchial wall thickening (42%). Echocardiography revealed impaired cardiac function in half of cases (51%) and coronary artery abnormalities in 14%. Cardiac MRI showed myocardial oedema in 58%, pericardial effusion in 42% and decreased left ventricular function in 25%. Twenty children required imaging for abdominal symptoms, the commonest abnormalities being free fluid (71%) and terminal ileum wall thickening (57%). Twelve children underwent brain imaging, showing abnormalities in two cases. CONCLUSION: Children with multisystem inflammatory syndrome showed pulmonary, cardiac, abdominal and brain imaging findings, reflecting the multisystem inflammatory disease. Awareness of the imaging features of this disease is important for early diagnosis and treatment.


Subject(s)
COVID-19/diagnostic imaging , Lung/diagnostic imaging , SARS-CoV-2/isolation & purification , Tomography, X-Ray Computed/methods , COVID-19/diagnosis , COVID-19/epidemiology , COVID-19 Nucleic Acid Testing , Child , Child, Preschool , Echocardiography , Female , Humans , Magnetic Resonance Imaging , Male , Pandemics , SARS-CoV-2/genetics , Systemic Inflammatory Response Syndrome
4.
Circulation ; 143(1): 21-32, 2021 01 05.
Article in English | MEDLINE | ID: covidwho-1004233

ABSTRACT

BACKGROUND: The aim of the study was to document cardiovascular clinical findings, cardiac imaging, and laboratory markers in children presenting with the novel multisystem inflammatory syndrome associated with coronavirus disease 2019 (COVID-19) infection. METHODS: This real-time internet-based survey has been endorsed by the Association for European Paediatric and Congenital Cardiologists Working Groups for Cardiac Imaging and Cardiovascular Intensive Care. Children 0 to 18 years of age admitted to a hospital between February 1 and June 6, 2020, with a diagnosis of an inflammatory syndrome and acute cardiovascular complications were included. RESULTS: A total of 286 children from 55 centers in 17 European countries were included. The median age was 8.4 years (interquartile range, 3.8-12.4 years) and 67% were boys. The most common cardiovascular complications were shock, cardiac arrhythmias, pericardial effusion, and coronary artery dilatation. Reduced left ventricular ejection fraction was present in over half of the patients, and a vast majority of children had raised cardiac troponin when checked. The biochemical markers of inflammation were raised in most patients on admission: elevated C-reactive protein, serum ferritin, procalcitonin, N-terminal pro B-type natriuretic peptide, interleukin-6 level, and D-dimers. There was a statistically significant correlation between degree of elevation in cardiac and biochemical parameters and the need for intensive care support (P<0.05). Polymerase chain reaction for severe acute respiratory syndrome coronavirus 2 was positive in 33.6%, whereas immunoglobulin M and immunoglobulin G antibodies were positive in 15.7% cases and immunoglobulin G in 43.6% cases, respectively, when checked. One child in the study cohort died. CONCLUSIONS: Cardiac involvement is common in children with multisystem inflammatory syndrome associated with the Covid-19 pandemic. The majority of children have significantly raised levels of N-terminal pro B-type natriuretic peptide, ferritin, D-dimers, and cardiac troponin in addition to high C-reactive protein and procalcitonin levels. In comparison with adults with COVID-19, mortality in children with multisystem inflammatory syndrome associated with COVID-19 is uncommon despite multisystem involvement, very elevated inflammatory markers, and the need for intensive care support.


Subject(s)
Arrhythmias, Cardiac , COVID-19 , Pericardial Effusion , SARS-CoV-2 , Shock , Systemic Inflammatory Response Syndrome , Adolescent , Antibodies, Viral/blood , Arrhythmias, Cardiac/blood , Arrhythmias, Cardiac/epidemiology , Arrhythmias, Cardiac/etiology , Arrhythmias, Cardiac/therapy , Biomarkers/blood , C-Reactive Protein/metabolism , COVID-19/blood , COVID-19/complications , COVID-19/epidemiology , COVID-19/therapy , Child , Child, Preschool , Europe/epidemiology , Female , Ferritins/blood , Fibrin Fibrinogen Degradation Products/metabolism , Humans , Immunoglobulin G/blood , Immunoglobulin M/blood , Infant , Interleukin-6/blood , Male , Natriuretic Peptide, Brain/blood , Pandemics , Peptide Fragments/blood , Pericardial Effusion/blood , Pericardial Effusion/epidemiology , Pericardial Effusion/etiology , Pericardial Effusion/therapy , Shock/blood , Shock/epidemiology , Shock/etiology , Shock/therapy , Systemic Inflammatory Response Syndrome/blood , Systemic Inflammatory Response Syndrome/complications , Systemic Inflammatory Response Syndrome/epidemiology , Systemic Inflammatory Response Syndrome/therapy
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