Critical Care (Nov 2020)

Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain

  • Alberto García-Salido,
  • Juan Carlos de Carlos Vicente,
  • Sylvia Belda Hofheinz,
  • Joan Balcells Ramírez,
  • María Slöcker Barrio,
  • Inés Leóz Gordillo,
  • Alexandra Hernández Yuste,
  • Carmina Guitart Pardellans,
  • Maite Cuervas-Mons Tejedor,
  • Beatriz Huidobro Labarga,
  • José Luís Vázquez Martínez,
  • Míriam Gutiérrez Jimeno,
  • Ignacio Oulego-Erróz,
  • Javier Trastoy Quintela,
  • Carmen Medina Monzón,
  • Laura Medina Ramos,
  • María Soledad Holanda Peña,
  • Javier Gil-Antón,
  • Clara Sorribes Ortí,
  • José Carlos Flores González,
  • Rosa María Hernández Palomo,
  • Inma Sánchez Ganfornina,
  • Emilia Fernández Romero,
  • María García-Besteiro,
  • Jesús López-Herce Cid,
  • Rafael González Cortés,
  • the Spanish Pediatric Intensive Care Society working group on SARS-CoV-2 infection

DOI
https://doi.org/10.1186/s13054-020-03332-4
Journal volume & issue
Vol. 24, no. 1
pp. 1 – 13

Abstract

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Abstract Background Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia. Methods A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared. Results Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (p = 0.002): 9.4 years (IQR 5.5–11.8) vs 3.4 years (IQR 0.4–9.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, p = 0.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, p < 0.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, p < 0.001), diarrhea (66.7% vs 11.5%, p < 0.001), vomits (71.1% vs 23.1%, p = 0.001), fatigue (65.9% vs 36%, p = 0.016), shock (84.4% vs 13.8%, p < 0.001) and cardiac dysfunction (53.3% vs 10.3%, p = 0.001). MIS-C group had a lower lymphocyte count (p < 0.001) and LDH (p = 0.001) but higher neutrophil count (p = 0.045), neutrophil/lymphocyte ratio (p < 0.001), C-reactive protein (p < 0.001) and procalcitonin (p < 0.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, p = 0.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, p < 0.001), corticosteroids (80% vs 44.8%, p = 0.003) and immunoglobulins (51.1% vs 6.9%, p < 0.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2.5–8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group. Conclusions MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS-C patients.

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