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American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS-CoV-2 and Hyperinflammation in Pediatric COVID-19: Version 3.
Henderson, Lauren A; Canna, Scott W; Friedman, Kevin G; Gorelik, Mark; Lapidus, Sivia K; Bassiri, Hamid; Behrens, Edward M; Kernan, Kate F; Schulert, Grant S; Seo, Philip; Son, Mary Beth F; Tremoulet, Adriana H; VanderPluym, Christina; Yeung, Rae S M; Mudano, Amy S; Turner, Amy S; Karp, David R; Mehta, Jay J.
  • Henderson LA; Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
  • Canna SW; Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine.
  • Friedman KG; Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
  • Gorelik M; Morgan Stanley Children's Hospital and Columbia University, New York, New York.
  • Lapidus SK; Joseph M. Sanzari Children's Hospital at Hackensack University Medical Center and Hackensack Meridian School of Medicine, Hackensack, New Jersey.
  • Bassiri H; Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine.
  • Behrens EM; Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine.
  • Kernan KF; University of Pittsburgh School of Medicine, Pittsburgh, Pennsylvania.
  • Schulert GS; Cincinnati Children's Hospital Medical Center and University of Cincinnati College of Medicine, Cincinnati, Ohio.
  • Seo P; Johns Hopkins University School of Medicine, Baltimore, Maryland.
  • Son MBF; Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
  • Tremoulet AH; University of California San Diego and Rady Children's Hospital San Diego, California.
  • VanderPluym C; Boston Children's Hospital and Harvard Medical School, Boston, Massachusetts.
  • Yeung RSM; The Hospital for Sick Children and University of Toronto, Toronto, Ontario, Canada.
  • Mudano AS; University of Alabama at Birmingham, Birmingham.
  • Turner AS; American College of Rheumatology, Atlanta, Georgia.
  • Karp DR; University of Texas Southwestern Medical Center, Dallas.
  • Mehta JJ; Children's Hospital of Philadelphia and University of Pennsylvania Perelman School of Medicine.
Arthritis Rheumatol ; 74(4): e1-e20, 2022 04.
Article in English | MEDLINE | ID: covidwho-1669371
ABSTRACT

OBJECTIVE:

To provide guidance on the management of Multisystem Inflammatory Syndrome in Children (MIS-C), a condition characterized by fever, inflammation, and multiorgan dysfunction that manifests late in the course of SARS-CoV-2 infection. Recommendations are also provided for children with hyperinflammation during COVID-19, the acute, infectious phase of SARS-CoV-2 infection.

METHODS:

The Task Force is composed of 9 pediatric rheumatologists and 2 adult rheumatologists, 2 pediatric cardiologists, 2 pediatric infectious disease specialists, and 1 pediatric critical care physician. Preliminary statements addressing clinical questions related to MIS-C and hyperinflammation in COVID-19 were developed based on evidence reports. Consensus was built through a modified Delphi process that involved anonymous voting and webinar discussion. A 9-point scale was used to determine the appropriateness of each statement (median scores of 1-3 for inappropriate, 4-6 for uncertain, and 7-9 for appropriate). Consensus was rated as low, moderate, or high based on dispersion of the votes. Approved guidance statements were those that were classified as appropriate with moderate or high levels of consensus, which were prespecified before voting.

RESULTS:

The guidance was approved in June 2020 and updated in November 2020 and October 2021, and consists of 41 final guidance statements accompanied by flow diagrams depicting the diagnostic pathway for MIS-C and recommendations for initial immunomodulatory treatment of MIS-C.

CONCLUSION:

Our understanding of SARS-CoV-2-related syndromes in the pediatric population continues to evolve. This guidance document reflects currently available evidence coupled with expert opinion, and will be revised as further evidence becomes available.
Subject(s)

Full text: Available Collection: International databases Database: MEDLINE Main subject: Rheumatology / COVID-19 Type of study: Prognostic study Topics: Long Covid Limits: Adult / Child / Humans Country/Region as subject: North America Language: English Journal: Arthritis Rheumatol Year: 2022 Document Type: Article

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Full text: Available Collection: International databases Database: MEDLINE Main subject: Rheumatology / COVID-19 Type of study: Prognostic study Topics: Long Covid Limits: Adult / Child / Humans Country/Region as subject: North America Language: English Journal: Arthritis Rheumatol Year: 2022 Document Type: Article