RESUMEN
OBJECTIVE: To describe the similarities and differences in the evaluation and treatment of multisystem inflammatory syndrome in children (MIS-C) at hospitals in the US. STUDY DESIGN: We conducted a cross-sectional survey from June 16 to July 16, 2020, of US children's hospitals regarding protocols for management of patients with MIS-C. Elements included characteristics of the hospital, clinical definition of MIS-C, evaluation, treatment, and follow-up. We summarized key findings and compared results from centers in which >5 patients had been treated vs those in which ≤5 patients had been treated. RESULTS: In all, 40 centers of varying size and experience with MIS-C participated in this protocol survey. Overall, 21 of 40 centers required only 1 day of fever for MIS-C to be considered. In the evaluation of patients, there was often a tiered approach. Intravenous immunoglobulin was the most widely recommended medication to treat MIS-C (98% of centers). Corticosteroids were listed in 93% of protocols primarily for moderate or severe cases. Aspirin was commonly recommended for mild cases, whereas heparin or low molecular weight heparin were to be used primarily in severe cases. In severe cases, anakinra and vasopressors frequently were recommended; 39 of 40 centers recommended follow-up with cardiology. There were similar findings between centers in which >5 patients vs ≤5 patients had been managed. Supplemental materials containing hospital protocols are provided. CONCLUSIONS: There are many similarities yet key differences between hospital protocols for MIS-C. These findings can help healthcare providers learn from others regarding options for managing MIS-C.
Asunto(s)
COVID-19/terapia , Protocolos Clínicos , Pautas de la Práctica en Medicina/estadística & datos numéricos , Síndrome de Respuesta Inflamatoria Sistémica/terapia , Antiinflamatorios no Esteroideos/uso terapéutico , Anticoagulantes/uso terapéutico , Antirreumáticos/uso terapéutico , Aspirina/uso terapéutico , COVID-19/diagnóstico , Niño , Estudios Transversales , Glucocorticoides/uso terapéutico , Heparina/uso terapéutico , Hospitales , Humanos , Inmunoglobulinas Intravenosas , Proteína Antagonista del Receptor de Interleucina 1/uso terapéutico , Encuestas y Cuestionarios , Síndrome de Respuesta Inflamatoria Sistémica/diagnóstico , Estados Unidos/epidemiología , Vasoconstrictores/uso terapéuticoRESUMEN
We present 7 children with congenital heart disease and coronavirus disease 2019. Of these, 5 were younger than 1 year of age and 3 had atrioventricular canal defect and trisomy 21. All 7 developed acute decompensation, with 1 death in an 18-year-old with hypertrophic cardiomyopathy and other comorbidities.