COVID 19 Related Multisystem Inflammatory Syndrome in Children Admitted to PICU in Ain Shams University Hospitals

Abstract

Background Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection is typically very mild and often asymptomatic in children. A complication is the rare multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19, presenting 4–6 weeks after infection as high fever, organ dysfunction, and strongly elevated markers of inflammation. Aim of the Work To evaluate the clinical profiles and risk factors for pediatric multisystem inflammatory syndrome in children with COVID-19 admitted to PICU. Patients and Methods This was a cross sectional study conducted on 45 patients admitted to pediatric intensive care unit (PICU) from June 2020 to August 2020, they were diagnosed as MIS-C cases according to CDC definition for MIS-C, using a score to assess hyperinflammatory syndrome, all patients were subjected to the following:(demographic data, clinical signs & symptoms at presentation, sequential organ failure assessment (SOFA) score and laboratory investigations. Results In our study MIS-C patients presented with 100% Kawasaki disease(KD)-like symptoms and 62.2% gastrointestinal symptoms in addition to fever with shock or cardiac dysfunction. Our patients presented with the following vital data: 100% were tachycardic and hypotensive according to centiles, peripheral capillary oxygen saturation (spo2) mean 94.5(2) %, fever of mean 39(0.6) degree celsius and SOFA score mean of 9(2). KD-like features were variably seen in patients (skin rash in 55.6%, conjunctivitis in 46.7% and Cardiovascular abnormalities were seen in 100% e.g. (myocardial dysfunction, valvular regurgitation, coronary dilatation, pericardial effusion and shock). In our patients, 13 patients (28.9%) had comorbid conditions, like (hematologic e.g. ALL, Cardiac e.g. ASD&VSD, Endocrinologic e.g. Diabetes mellitus), 4 of them died revealing comorbidities as a cause of higher mortality with significant p value (0.028). 39 patients (86.7%) were discharged and 6 patients (13.3%) died. Conclusion MIS-C is a hyper-infammatory syndrome affecting multiple organs and is triggered by SARS-CoV-2 infection. It is usually seen 2–4 weeks following infection. comorbidities significantly affected the short term outcome of the disease.