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2.
Indian Journal of Pediatrics. ; 2023.
Article in English | EMBASE | ID: covidwho-2208150
3.
Pakistan Paediatric Journal ; 46(4):444-447, 2022.
Article in English | EMBASE | ID: covidwho-2207981

ABSTRACT

Multi-system inflammatory syndrome in children is a rare complication of corona virus-19 infection characterized by fever, inflammatory changes in body and multi-organ dysfunction or features consistent with incomplete/complete Kawasaki disease. We are presenting two cases of post-covid syndrome (MIS-C) in children. Copyright © 2022, Pakistan Pediatric Journal. All rights reserved.

4.
Lekarsky Obzor ; 71(3):116-121, 2022.
Article in Slovak | Scopus | ID: covidwho-2207531

ABSTRACT

The outbreak of a new coronavirus disease (COVID-19), caused by SARS-CoV-2, appears to be the greatest medical challenge of the last decade. In adult patients, COVID-19 affects the lungs in particular, manifesting in the form of interstitial pneumonitis (NSIP) and acute respiratory distress syndrome (ARDS). According to available data, COVID-19 in children is less common and has a milder course, often in the form of asymptomatic carriage or with digestive problems only. It is very likely that the occurrence of the infection caused by SARS-CoV-2 in this age group is underestimated. Currently, it is estimated to range from 0.9 to 12 percent in the paediatric population. The latest data on new mutations of the virus suggest its new "peculiarities”. It has turned out that the SARS-CoV-2 virus is becoming more infectious, from the summer months there has been a growing incidence of the disease in children and, moreover, there are more and more cases when it causes damage to various organs, including the brain. Temporal association with the COVID-19 infection reveals new units: paediatric multisystem inflammatory system temporally associated with SARS-CoV-2 (PIMS-TS / MIS-C / Kawa-COVID-19) – a systemic inflammatory disease of unknown etiology, similar to the Kawasaki disease or the Kawasaki shock syndrome, with sudden onset of cardiogenic and circulatory shock. Symptoms of Kawa-COVID-19 occur in paediatric patients approximately 2 – 4 weeks after recovery from SARS-CoV-2 and the most common complication occurring in 50% cases is myocarditis. Development of vasculitis may also lead to aneurysms and other cardiovascular complications. Much depends on the stage of the disease in which the child is admitted to the hospital, as well as on how fast the treatment is initiated. The objective of this article is to draw the attention of the expert public to the previously mentioned risks and to prevent potential cardiovascular complications © 2022, Lekarsky Obzor.All Rights Reserved.

5.
Open Forum Infectious Diseases ; 9(Supplement 2):S730, 2022.
Article in English | EMBASE | ID: covidwho-2189878

ABSTRACT

Background. Classification of MIS-C, COVID-19, and other pediatric inflammatory conditions is challenged by phenotypic overlap and absence of diagnostic laboratory evidence. Due to public health need and based on limited data from early cases, CDC developed a necessarily broad MIS-C surveillance case definition in May 2020. Studies have since shown that some criteria do not distinguish between MIS-C and other conditions and may contribute to misclassification. To inform planned revision to the CDC definition, we evaluated the impact of narrowing these criteria on case inclusion in national MIS-C surveillance. Methods. Of state and local health-department reported cases meeting the current MIS-C case definition as of 04/14/2022, we describe the proportion that met revised criteria under consideration including fever duration, C-reactive protein (CRP) elevation using a defined cutoff, and organ involvement represented by specific criteria. We also evaluated cases identified using potential combinations of revised criteria. Results. Of 8,096 MIS-C cases fulfilling the original case definition, 6,332 (78%) had sufficient data for evaluation of criteria. Of these, 96% had fever for >=2 days and 94% had a CRP >= 3.0 mg/dL (Table 1). Cardiac involvement defined by key features of MIS-C was present in 84% of cases (62% if BNP/proBNP elevation was excluded);43% had shock. Dermatologic, gastrointestinal (GI) and hematologic involvement were present in 75%, 89% and 37% of cases, respectively. Neurologic (excluding headache), renal, and respiratory involvement were present in 16%, 20%, and 63% of cases, respectively. The number of cases with >= 2 of cardiac (without BNP/proBNP elevation), shock, dermatologic, GI, or hematologic involvement was 5,733 (91%). SARS-CoV-2 testing results are shown in Table 2. Conclusion. The CDC MIS-C case definition is intentionally broad. Using national surveillance data, we evaluated case inclusion under narrower criteria, prioritizing features of MIS-C that distinguish it from similar pediatric inflammatory conditions. A surveillance case definition may not capture all cases and is not intended to replace clinical judgment. We plan to assess additional criteria combinations, describe potentially excluded cases, and incorporate findings into a revised definition.

6.
Open Forum Infectious Diseases ; 9(Supplement 2):S465, 2022.
Article in English | EMBASE | ID: covidwho-2189748

ABSTRACT

Background. CDC began collecting COVID-19 vaccination status of persons with MIS-C as part of national surveillance inMay, 2021. We describe and compare MIS-C in fully vaccinated persons withMIS-C in persons with partial or no vaccination reported. Methods. We identified COVID-19 vaccine age-eligible persons meeting the CDC MIS-C case definition reported by health departments as of March 28, 2022 and divided theminto 3 groups for this analysis: 1) fully vaccinated (receipt of a 2-dosemRNAprimary vaccine series with MIS-C onset >=28 days after vaccine dose 2 to account for the delay between infection and MIS-C), 2) partially vaccinated (MIS-C onset after dose 1 or < 28 days from dose 2 or receipt of Janssen [Johnson & Johnson] vaccine and 3) no vaccination reported. We compared characteristics between the groups. Results. Of 7,880 MIS-C cases reported, 1,085 were vaccine eligible: 45 were fully vaccinated, 64 partially vaccinated, and 976 had no vaccine reported. Demographic characteristics were similar, although the Northeast had the lowest percentage of persons with vaccination not reported (Table). Though not statistically significant, fully vaccinated persons less frequently had severe cardiac involvement (67% vs 74%), shock (33% vs 44%), severe hematologic involvement (47% vs 54%), and mucocutaneous involvement (53% vs 63%) compared with those with no vaccine reported (Table). Forty-four percent of those fully vaccinated required ICU-level care vs 59% with no vaccine reported (p=0.053). Nineteen (2%) of those without vaccine reported died;no fully or partially vaccinated persons died. (Table Presented) Conclusion. Persons who acquire SARS-CoV-2 infection after being fully vaccinated can develop MIS-C, with similar clinical characteristics to those with no vaccination reported. A lower but not statistically significant percentage of fully vaccinated persons required ICU-level care compared with those without vaccination, and there were no deaths in the fully vaccinated group. These data do not account for trends in MIS-C over time, including the influence of circulating SARS-CoV-2 variants on MIS-C clinical manifestations. We will continue to evaluate these comparisons as the sample size of reported MIS-C cases increases.

7.
Journal of the Pediatric Infectious Diseases Society. ; 11, 2023.
Article in English | EMBASE | ID: covidwho-2170966
8.
Pediatricheskaya Farmakologiya ; 19(2):105-114, 2022.
Article in Russian | EMBASE | ID: covidwho-2067386

ABSTRACT

This article describes various COVID-19 dermatological manifestations that can develop in children. Their incidence and clinical features are described. Сhilblain-like lesions were considered as the most typical in children population after coronavirus infection. Description of skin manifestations in multisystem inflammatory syndrome in children is also presented, issues of laboratory diagnosis are covered as well.

9.
Archives of Disease in Childhood ; 107(Supplement 2):A363, 2022.
Article in English | EMBASE | ID: covidwho-2064046

ABSTRACT

Aims Background Alder Hey is a tertiary children's hospital in North-West England with co-located Intensive Care and High Dependency units, covering North West England, North Wales and Isle of Man. PIMS-TS is a new multisystem inflammatory condition which has led to an increased demand on critical care beds. Some children presenting with PIMS-TS need haemodynamic support in the form of inotropes, which would traditionally need an PICU bed. Aim Review of all patients managed on Critical Care with PIMS-TS. Methods All patients in the region were discussed in a PIMSTS multidisciplinary meeting attended by Paediatrics, Infectious Diseases, Rheumatology, Cardiology and Critical Care daily. Patients across the region needing haemodynamic support or cardiology evaluation were highlighted as, in need of either HDU or PICU bed and transferred by the North West & Wales Paediatric Transport Service (NWTS). This is a retrospective analysis of all children admitted to HDU or PICU with a diagnosis of PIMS-TS, from October 2020-December 2021. Results Thirty (10%) patients were admitted to HDU from the 300 patients discussed over the 15month period. 16 (53%) of patients were female. Mean age was 10 years (range 3-17). Median length of stay (LOS) on HDU was 2 days (range 1-8) with a median hospital LOS of 6 days (range 2- 10). All patients admitted were monitored appropriately and had full echocardiography assessment. Twenty nine (97%) patients admitted to HDU required inotropic support, twelve (40%) patients required a single agent and seventeen (57%) required double agents with a combination of adrenaline, noradrenaline and milrinone. Median fluid resuscitation was 40mls/kg (range 20-70mls/ kg). Eight patients (27%) were escalated to PICU for either invasive ventilation (4) or higher inotropic requirements of 0.2micrograms/kg/minute. There were no adverse events. Conclusion Most children with PIMS-TS have low to moderate haemodynamic instability that can be safely managed on HDU with appropriate monitoring and agreed limits to vasopressor therapy. Our experience in managing with these patients successfully and safely in a high dependency setting has helped in the use of a critical care bed efficiently, thus reducing dependency on the availability of a PICU bed.

10.
Archives of Disease in Childhood ; 107(Supplement 2):A261, 2022.
Article in English | EMBASE | ID: covidwho-2064031

ABSTRACT

Aims Anakinra is an Interleukin-1 receptor (IL-1) antagonist;a biologic drug that has historically been used as part of longerterm management in methotrexate-resistant rheumatoid arthritis, cryopyrin-associated periodic syndromes and systemic juvenile idiopathic arthritis. We describe its successful use in acute multisystem inflammation in a cohort of recently treated children in a Tertiary Children's Hospital. Methods We reviewed the details of 6 acutely unwell inpatients admitted over the last 6 months, with acute multisystem inflammation, who had been treated with Anakinra as a rescue medication, following resistance to first-line anti-inflammatory medications. Five of these patients had been diagnosed with Paediatric Multisystem Inflammatory Syndrome temporarily associated with COVID-19 (PIMS). One of these patients had been diagnosed with Hemophagocytic Lymphohistiocytosis (HLH). Results The average length of initial treatment was 3.5 days before commencing Anakinra. All patients on Anakinra also received contemporaneous intravenous methylprednisolone treatment (IVMP), and 5/6 patients had received intravenous immunoglobulin therapy (IVIG). Common indications for commencing Anakinra were: persisting fevers despite at least 3 days of IVMP, and increasing inflammatory markers despite first line treatment. The average C-reactive Protein (CRP) at initiation of Anakinra was 82 (range 32 to 132) and the average Ferritin at initiation was 1500 (range 129 to 4640), with the average treatment duration of 6.7 days until CRP normalised, and all with normal CRP two weeks after treatment. All patients were started on an initial 2mg/kg dose of Anakinra, rounded up to nearest 100mg dose in most. Five patients were prescribed a subcutaneous route whilst one patient was started on an IV route. Half of patients were commenced on a once daily regime, two patients were started on a twice daily regime, and one patient was started on a QDS regime. One patient required a dose increase due to ongoing fevers after initiation. Average treatment length for the patients diagnosed with PIMS was 8.6 days, whereas treatment length was 25 days in the patient with HLH. We also describe the need for inotropic support (1/5), significant echocardiography findings at presentation (3/5) and at 2 weeks post-discharge (1/5) in this cohort of patients with PIMS. Conclusion Anakinra was successfully used as an acute treatment for our 6 described patients with multisystem inflammation. With more recent waves of PIMS, Anakinra has increasingly been used as a second-line treatment. Its introduction ceased ongoing fevers in all patients;5 of 6 with immediate effect. There are some clear advantages of Anakinra as a rescue drug over other potential biological alternatives, namely;choice of preparation, tolerability and few described side effects with short-term use. We highlight the experiential effectiveness of the acute use of Anakinra in our cohort of children with hyperinflammation, and recommend its accessibility as an emergency drug.

11.
Archives of Disease in Childhood ; 107(Supplement 2):A207, 2022.
Article in English | EMBASE | ID: covidwho-2064029

ABSTRACT

Aims Paediatric populations are generally considered to be at a lower risk of mortality from COVID-19 infection compared with adult populations. Regardless, a notable number of deaths from COVID-19 have been reported in paediatric populations. Therefore, the purpose of our work was to conduct a scoping review of the literature to assess the risk factors for COVID-19 mortality among paediatric populations. Methods Our review was conducted according to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses Extension for Scoping Reviews (PRISMA-ScR). Searches were performed in PubMed, Scopus, medRxiv, and WHO Coronavirus Database. There were no restrictions placed for searches based on date. Papers that were written in English, included at least one paediatric death from COVID-19, and described at least one risk factor for the death and/or clinical presentation of the child(ren) were eligible for inclusion. The paediatric population was defined as children aged 18 years and younger. Results Searches generated a total of 5828 papers and, of those, 75 were eligible for inclusion. There was a pooled total of 876 paediatric deaths. Significant risk factors for paediatric mortality included having co-infection of other pathogens, and at least one comorbidity;the comorbidities most frequently associated with mortality were malignancies, heart conditions, kidney disease, and genetic disorders such as Down Syndrome. The development of Paediatric Multisystem Inflammatory Syndrome (PMIS) was also consistently demonstrated to be a risk factor. Common clinical complications associated with paediatric COVID-19 infection resulting in mortality were sepsis, acute respiratory distress syndrome (ARDS), and acute kidney injury (AKI). Conclusion Our review has highlighted prominent risk factors for mortality from COVID-19 amongst paediatric populations. It is vital to consider the risk factors in order to assist prognostication and clinical decisions for severe paediatric infections of COVID-19. Our findings also highlight the importance of COVID-19 vaccination in paediatric populations.

12.
Archives of Disease in Childhood ; 107(Supplement 2):A203-A204, 2022.
Article in English | EMBASE | ID: covidwho-2064028

ABSTRACT

Aims Multisystem inflammatory syndrome in children (MIS-C) secondary to severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has affected not only the older children, adolescents and adults but also infants, more so during the second wave of the global pandemic. Thus, this study was done to describe the profile of infants presenting with multisystem inflammatory syndrome (MIS) with the aim to alert clinicians regarding the need for its early diagnosis and timely management in this vulnerable age group to prevent the morbidity, mortality and long term complications associated with MIS-C. Methods All sequentially admitted infants hospitalized during a period of 6months from,who fulfilled the WHO/CDC/RPCH criteria for MIS-C were included in the study. The data was recorded in a semi-structured pre-tested self-designed proforma regarding the demographic profile, presenting symptoms, clinical signs, laboratory parameters and treatment received. The data was analysed using appropriate statistical tools. Results A total of 19 infants were studied. Of these, 68.3% (13) had an evidence of recent COVID-19 infection. The median age of presentation was 2 months. The male:female ratio was 1.1:1. The most common presenting symptoms were fever (68.4%), gastrointestinal complaints (63.1%) and edema (36.8%) (figure 1). Other predominant signs were shock (78.9%), myocarditis (52.6%) and neurological complaints (26.3%). Incomplete Kawasaki disease was present in 21% patients. Elevated CRP, ferritin, D-Dimer, NT pro BNP and reduced fibrinogen were markers of severe illness. All subjects received IVIG (100%), 31.5% received a second dose of IVIG and 63.1% received pulse intravenous methylprednisolone. (table 1) A total of 5(26.3%) died as a result of the disease process. Conclusion MIS-C in infants is usually under-diagnosed and under-reported due to the considerable overlap between sepsis and MIS-C especially due to the higher incidence of sepsis in developing countries. The spectrum of this illness can be varied and is different from the overt clinical signs seen in older children and adolescents. Thus, these investigations should be done early in the course for optimal therapy with immunomodulators and favourable outcome.. (Figure Presented).

13.
Archives of Disease in Childhood ; 107(Supplement 2):A17-A18, 2022.
Article in English | EMBASE | ID: covidwho-2064010

ABSTRACT

Aims The Omicron variant of SARS-CoV-2 variant has rapidly spread in the UK since December 2021.There was a significant increase in the number of children testing positive for SARS-CoV-2 in December 2021 in the population served by this DGHS. A clustering of cases of PIMS- TS was noted in the last week of December 2021 and the first week of January 2022. The focus of this descriptive study of PIMS-TS patients from a single centre is to report the clustering of cases in the Omicron dominant period and to describe the dilemma of managing children who present with fever and pain abdomen. Methods Children confirmed to have PIMS-TS and one child who presented mimicking PIMS -TS were identified, their investigations, treatment and outcomes were reviewed Results A cluster of 6 children diagnosed as PIMS -TS presented from the 29th of December 2021 to the 8th of January 2022.The mean age of patients was 9.3 years. There was ethnic variation with 3 Asian, 2 Afro Caribbean and one White child. Mean CRP was 226( range 85-400). All children presented with fever of more than 3 days.3 children presented with partial Kawasaki features, 2 children were treated for shock and 2 children presented with pain abdomen and fever. A 15 year old presented with fever, pain abdomen and tenderness in the right iliac fossa. He was managed initially as appendicitis. Blood markers for PIMS-TS were significantly raised along with raised CRP of 204. CT abdomen showed ileitis. His NPA RT- PCR was positive for SARS-CoV-2. He continued to have high fever, a diagnosis of PIMS-TS was made. There was significant improvement in both clinical condition and biochemical markers following IV Methylprednisolone. On the same day a 11 year old presented with fever, pain abdomen and increased irritability. He had global developmental delay and was PEG fed. He was initially managed as PIMS-TS then diagnosed to have appendicitis. CT abdomen showed a perforated appendix. He had a good outcome after surgery Conclusion The clustering of cases of PIMS- TS may be specific to this geographical area and multi-ethnic population following a period of high SARS-CoV-2 prevalence in the community with the Omicron variant. PIMS-TS can closely mimic appendicitis and distinguishing between both can be difficult. In the first child, CRP was unusually high (202) which helped in making a diagnosis avoiding unnecessary surgery. In the second child clinical acumen and involvement of multiple specialist teams helped in making the diagnosis of appendicitis. The global developmental delay and the child being nonverbal proved to be confounding factors. Cases of PIMS-TS can have bowel inflammation, it is also possible that COVID-19 can occur with other pathologies. Radiology findings need to be interpreted with the clinical picture. Clinical acumen, considering a range of differentials working closely with other specialities enables us to make a correct diagnosis for the unwell child who presents in the COVID-19 pandemic.

14.
American Journal of Transplantation ; 22(Supplement 3):765, 2022.
Article in English | EMBASE | ID: covidwho-2063490

ABSTRACT

Purpose: The purpose of the study was to examine the clinical course, outcomes, and complications of COVID-19 in pediatric solid organ transplant patients from a single institution, with special attention to thrombotic complications, multiple inflammatory syndrome in children (MIS-C), and new rejection. Method(s): The medical record at our institution was retrospectively queried for all solid organ transplant patients up to 21 years old diagnosed with COVID-19 from March 2020 to September 2021. This cohort was compared in a 1:1 fashion with age, sex, and ethnicity-matched controls with COVID-19 infection, but no history of transplant. Categorical variables were analyzed with Chi-square or Fisher's exact test, and continuous variables were analyzed with Mann-Whitney test. Result(s): 44 solid organ transplant patients met study inclusion criteria. Six patients were excluded from analysis due to insufficient documentation of COVID-19 diagnosis or course. The cohort was composed of 17 kidney, 11 heart, six liver, two lung, one liver-kidney, and one multivisceral transplant patients. Median age at COVID-19 diagnosis was 15 years (IQR 9). Median time from transplant to COVID-19 diagnosis was 2.5 years (IQR 3.4). Of the 38 patients, 17 were white non-Hispanic/Latino (44.7%), 12 were Hispanic/Latino (31.6%), three were Black (7.9%), two were Asian (5.3%), three were other (7.9%), and one was unknown (2.6%). 19 patients (50%) were male. 12 transplant patients were asymptomatic (31.6%), compared to five controls (13.2%, p=0.054). Of the symptomatic patients, the most common symptoms in the solid organ transplant group were fever (26.3%) and headache (18.4%), with few patients experiencing shortness of breath (5.3%). Hospital (15.8%) and ICU (5.3%) admission rates were equal in both groups, with a median length of stay of 4.5 days for the transplant group (IQR 5.25) versus 4 days (IQR 5.75) for controls (p=0.59). 32 patients in each group received supportive care as outpatients (84.2%). A minority of transplant patients received monoclonal antibody (6.3%), convalescent plasma (6.3%), steroids (6.3%), and remdesivir (3.1%). There was one case of MIS-C in the transplant group (2.6%) versus three in the control group (7.9%) (p=0.62). One transplant patient developed COVID-associated microangiopathy (2.6%), but there were no thrombotic complications among controls (p > 0.99). There were no new cases of cellular or antibody-mediated rejection following COVID-19. There was one death in the transplant cohort, but no deaths in the control group. Conclusion(s): We report the largest multi-organ cohort of pediatric solid organ transplant recipients with COVID-19 to date. Our findings suggest pediatric solid organ transplant patients fare similarly to healthy children, without elevated risk of complications.

15.
RoFo Fortschritte auf dem Gebiet der Rontgenstrahlen und der Bildgebenden Verfahren ; 194(9):952, 2022.
Article in German | EMBASE | ID: covidwho-2062310
16.
Cardiology in the Young ; 32(Supplement 2):S171-S172, 2022.
Article in English | EMBASE | ID: covidwho-2062129

ABSTRACT

Background and Aim: Cardiac involvement is seen in the majority of cases with multisystem inflammatory syndrome in children (MIS-C). Various rhythm and conduction disturbances, as well as repolarization abnormalities, have been described by more than 50% of the patients, while there are few cases with complete heart block or with asystole. Method(s): Case report Results: 8-year old girl presented with a 5-day history of fever, cough, headache, and abdominal pain. Because of the critical con-dition, with respiratory insufficiency and heart failure symptoms, the child was intubated and started on inotropic support. ECG showed complete AV-block with a ventricular rate of 75/min and with ST-T changes;echocardiography revealed dilated left ventricle with reduced contractility, CT-scan of the lungs showed bilateral pneumonia, the inflammatory markers were elevated, in combination with high troponin levels, and positive SARS-CoV2-IgG antibodies. The diagnosis MIS-C was made and treatment with immunoglobulins, antibiotics, corticosteroids, and anticoagulants was initiated. During the next 2 days, the cardiac function deteriorated further, and while still on mechanical ventilation and inotropic support, extreme bradycardia with a ventricular rate of 35/min was regis-tered, and the patient was indicated for temporary emergency pac-ing. Upon induction of anesthesia, the child became asystolic, requiring extensive resuscitation. After circulation recovery, the ECG showed nodal tachycardia with a heart rate of 140-170/min. A temporary transvenous pacemaker (PM) was inserted, and the patient was started on intravenous amiodarone which resulted in a slower ventricular rate of 70/min. 3 days later sinus rhythm was restored, with first-degree AV-block, which allowed removal of the PM 5 days after its insertion. Left ventricular dimensions were normalized and contractility remained low-normal (EF 56%). During the 6-month follow-up, the ECG and the Holter-monitoring showed sinus rhythm with first-degree AV-block. Magnetic resonance imaging (MRI) on day 15 of the hospital stay demonstrated scattered areas of myocarditis and ischemia predominantly in the left ventricle, as well as thickening of the basal septum. Six months later the MRI changes were reduced but still persistent. Conclusion(s): MIS-C can present with serious and life-threatening rhythm and conduction disturbances in children;this is why extensive cardiac monitoring is obligatory by all patients.

17.
Cardiology in the Young ; 32(Supplement 2):S103, 2022.
Article in English | EMBASE | ID: covidwho-2062128

ABSTRACT

Background and Aim: Pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS) is a postim-munological reaction after SARS-CoV-2 infection. Various car-diac manifestations of PIMS-TS have been reported, namely pericardial effusion, ventricular arrhythmia, myocarditis, valvular regurgitation, and pericarditis. The aim of this study was to analyze clinical and laboratory features to distinguish any possible predic-tion for cardiac involvement in children with PIMS. Method(s): The PIMS patients under 18 years old treated in our center between July 2020 and December 2021 were included. Data of the patients were retrospectively obtained from their medical records. Result(s): A total of 46 patients with PIMS were examined during the study period. The mean age of study group was 9.4 +/- 4.6 years, 18/46 were female and 3 groups were formed according to their age ranges. Among them, seventeen patients (37%) had cardiac involvement with mean age was 8.7 years. Impaired cardiac func-tions were seen more in male patients (n: 10/17). Coronary artery dilatation seen in seven patients especially with mean age of 5.2 years (Age group 1,2,3;%36.4,%14.3,%0;p = 0.033;respectively) and especially related to high troponin T levels (p = 0.006). In our study group, cardiac involvement was shown more related to ProBNP and Troponin T (p = 0.008;p = 0.003). The cut-off val-ues of proBNP and troponin T for predicting in cardiac dysfunc-tion were 2759 pg/mL (95% confidence interval (CI), 0,83-1;sensitivity, 0.86;specificity, 0.93;AUC:0.92, p lt;0,001). Conclusion(s): Although there is a wide variability of symptoms, MIS-C is a rare, severe, less understood complication of COVID-19 that may cause multisystemic involvement in the patients. Clinicians should be aware of this condition in children with persistent fever and a family history of COVID-19. Cardiac involvement in chil-dren with PIMS may strongly be predicted by levels of Troponin T and ProBNP. Further more younger age and high Troponin T levels are the independent predictors for the coronary artery dila-tation among children with PIMS.

18.
Cardiology in the Young ; 32(Supplement 2):S253-S254, 2022.
Article in English | EMBASE | ID: covidwho-2062127

ABSTRACT

Background and Aim: A 15 year old young man with symptoms and signs consistent with MIS-C was admitted to the Intensive Care Unit for inotropic support as he was exhibiting signs of cardiogenic shock. He was previously fit and healthy and he had been exposed to Covid 19 confirmed cases 6-8 weeks prior to becoming unwell. Method(s): The patient received IVIG and steroids as an immuno-modulating regime. On the admission echocardiogram there was a structurally normal heart with large LV thrombuses. The D-Dimers were extremely elevated on admission and the patient received therapeutic heparin infusion. Other prothrombotic causes were excluded. Result(s): The surveillance echocardiogram 24h post admission showed resolution of the thrombuses. The patient never exhibited any signs or symptoms of cardiac ischaemia on the electrocardio-gram or regional wall motion abnormality on the echocardiogram or neurologic impairment and the brain MRI-MRA one week post admission was normal. The patient was discharged home 5 days post admission and on follow ups up to a year after the acute phase remains very well physically and clinically. Conclusion(s): Thromboembolic events are frequently described in COVID-19 patients and in some patients with MIS-C and are the consequence of a hyperinflammatory response and endothelial dysfunction. There might be a potential role of an antiphospholi-pid syndrome secondary to severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection as has been proposed. An increase in D-dimer level has been shown to be associated with thromboembolic events, including arterial thrombosis especially in the older population and should be investigated promptly. With the appropriate immunomodulation and antithrombotic treat-ment adverse events are prevented. More studies to assess endothelial function and its role in the MIS-C prothrombotic state are necessary.

19.
Cardiology in the Young ; 32(Supplement 2):S87, 2022.
Article in English | EMBASE | ID: covidwho-2062123

ABSTRACT

Background and Aim: Growing evidence has documented a severe systemic hyperinflammation syndrome affecting children previ-ously exposed to SARS-CoV-2, known as Multisystem Inflammatory Syndrome in Children (MIS-C). Cardiovascular manifestations in MIS-C are frequent (34%-82%). The aim of our study was to describe the early and late cardiac abnormalities in patients with MIS-C, assessed by standard echocardiography, speckle tracking echocardiography (STE), and cardiac MRI (CMR). Method(s): 32 consecutive patients (21M, 11F), mean age 8.25 +/- 4years (range 1.3-17.7), with confirmed MIS-C diagnosis were enrolled in this study. Clinical, laboratory and microbiological data were collected. At disease onset, all children underwent standard transthoracic echocardiography, STE with analysis of left ventricle global longitudinal strain (GLS) and 23 (75%) of them performed CMR. Patients underwent complete cardiological evaluation, including echocardiography and STE at two months (T1) and six months (T2) after diagnosis. CMR was repeated at six months after diagnosis. Result(s): Cardiovascular symptoms were present in 45.8% of cases. Thirteen children (40.6%) shared Kawasaki Disease-like symp-toms, and 5 (15.6%) needed ICU admission. Early survival was 100%. All patients showed an hyperinflammatory state. Tn-I was elevated in 20 (62.5%) and BNP in 28 (87.5%) patients. Mean LVEF at baseline was 58.8 +/- 10% with 10 patients (31%) below 55%. STE showed reduced mean LV GLS (-17.4 +/- 4%). On CMR, LGE with nonischemic pattern was evident in 8/23 patients (35%). Follow-up data showed rapid improvement of LVEF at T1 (62.5 +/- 7.5 vs. 58.8 +/- 10.6%, p value 0.044) with only three patients (10%) below <= 55% at T1 and one (4%) at T2. LV GLS remained impaired at T1 (-17.2 +/- 2.7 vs.-17.4 +/- 4, p value 0.71), and significantly improved at T2 (-19 +/- 2.6% vs.-17.4 +/- 4%, p value 0.009). LV GLS was impaired (gt;-18%) in 53% of patients at baseline and T1, while only 13% showed persistent LV GLS reduc-tion at T2. Follow-up CMR showed LGE persistence in 33.4% of cases. Conclusion(s): Even though, early cardiac involvement significantly improves during follow-up, subclinical myocardial damage seems to be still detectable 6 months follow up in one third of MIS-C patients.

20.
Cardiology in the Young ; 32(Supplement 2):S183, 2022.
Article in English | EMBASE | ID: covidwho-2062120

ABSTRACT

Background and Aim: Multisystem inflammatory syndrome in chil-dren (MIS-C) is a late manifestation of SARS-CoV-2 infection. Cardiac involvement is common and presents as ventricular dys-function, shock, and coronary anomalies. The aim of the study is evaluate the influence of cardiac disfunction on clinical presen-tations and outcomes in a single center. Method(s): A retrospective study on patients diagnosed with MIS-C and referred to Buzzi Children's Hospital in Milan from November 2020 to February 2021. Patients were treated with intravenous immunoglobulins, corticosteroids and anti-throm-botic prophylaxis, in respect to our approved multidisciplinary protocol. According to the admission cardiac left ventricular ejec-tion fraction (LVEF), the patients were divided into group A (LVEF lt;45%) and group B (LVEF >=45%). Result(s): We collected 32 consecutive patients. Group A included 10 patients (9M/1F, aged 13 years [IQR 5-15]), and group B included 22 patients (15M/7M, aged 9 years [IQR 7-13]). At the presentation, significant differences were observed among shock (group A 6/10 vs group B 2/22, plt;0.01), gastrointestinal involvement (9/10 vs 11/22, p = 0.04) and duration of fever (5.3 vs 6.9 days, p = 0.02). All patients in group A required inten-sive care hospitalization (10/10 vs 12/22, p = 0.01). Interestingly, despite good cardiac function, two patients in group B presented with shock, probably due to vasoplegic/distributive cardiocircula-tory impairment secondary to the inflammatory state. Among biochemistry parameters, leukocytes, neutrophils, and CRP were significantly worse in group A (p = 0.001, p = 0.001 and p = 0.008, respectively). Pathological level of troponin T and NTproBNP were detected in all patients in group A and also in 33% and 77% of group B;with statistically significant higher median values in group A (Troponin T 72 [40-243] ng/L vs 22 [8-49] ng/L, p = 0.01;NTproBNP 14825 [11340-17810] ng/L vs 5921 [1114-11243] ng/L, p = 0.01). In group A, mitral regurgitation was more frequent (plt;0.01) and one patient had transient left main coronary dilation (Boston z-score +2.39). At the discharge, cardiac function normalized in all patients. Total length of hospital stay and cardiac recovery time were not statistically different between groups. Conclusion(s): If correctly diagnosed and early treated, all the MIS-C patients completely recovered, regardless of the initial cardiac involvement.

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