1
|
Alam A, Andriyani FM, Peryoga SU. Severe COVID-19 multisystem inflammatory syndrome versus severe dengue in children from Indonesia: a cross-sectional study. Int J Emerg Med 2024; 17:85. [PMID: 38992604 PMCID: PMC11242006 DOI: 10.1186/s12245-024-00658-6] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 06/25/2024] [Indexed: 07/13/2024] Open
Abstract
INTRODUCTION Severe multisystem inflammatory syndrome in children (MIS-C) and severe dengue are challenging to identify during the COVID-19 pandemic in dengue-endemic areas. Fever, multiorgan involvement, and shock characterize both severe MIS-C and severe dengue. Distinguishing between the two diseases is beneficial in initiating proper management. METHODS Medical records of children < 18 years old who were hospitalized at Hasan Sadikin General Hospital's PICU between December 2020 and July 2022 with severe MIS-C or severe dengue were recorded. Differences were assessed using comparative and descriptive analyses. RESULTS Seventeen severe dengue patients and 4 severe MIS-C were included. The average age of severe MIS-C was 11.5 years (SD ± 2.9, 95% CI), and that of severe dengue patients was 6.2 years (SD ± 4.4, 95% CI) (p value = 0.034, 95%). Fever and abdominal pain were the most common symptoms in both groups (p = 0.471, 95% CI). Rash (p = 0.049) and nonpurulent conjunctivitis (p = 0.035) were two symptoms with significant differences. The highest platelet count (p-value = 0.006, 95% CI), AST (p-value = 0.026, 95% CI), and D-dimer level (p-value = 0.025, 95% CI) were significantly different between the two cohorts. Cardiac abnormalities were found in all (100%) severe MIS-C patients, but only one (5.9%) in severe dengue patients. CONCLUSION Age, rash, nonpurulent conjunctivitis, platelet count, AST and D-dimer level may distinguish severe MIS-C from severe dengue fever.
Collapse
Affiliation(s)
- Anggraini Alam
- Infection & Tropical Diseases Division, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran-Hasan Sadikin General Hospital, Bandung, Indonesia.
| | - Fina Meilyana Andriyani
- Emergency and Intensive Care Division, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran-Hasan Sadikin General Hospital, Bandung, Indonesia
| | - Stanza Uga Peryoga
- Emergency and Intensive Care Division, Department of Child Health, Faculty of Medicine, Universitas Padjadjaran-Hasan Sadikin General Hospital, Bandung, Indonesia
| |
Collapse
|
2
|
Tran DM, Pham DV, Cao TV, Hoang CN, Nguyen HTT, Nguyen GD, Le CN, Thieu QQ, Ta TA, Dau HV, Le CQ, Le QH, Luong NT, Tran MT, Nguyen PH, Nguyen NT, Phan PH. Severity predictors for multisystemic inflammatory syndrome in children after SARS-CoV-2 infection in Vietnam. Sci Rep 2024; 14:15810. [PMID: 38982132 PMCID: PMC11233495 DOI: 10.1038/s41598-024-66891-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/13/2024] [Accepted: 07/05/2024] [Indexed: 07/11/2024] Open
Abstract
Multisystemic inflammatory syndrome in children (MIS-C) might manifest in a broad spectrum of clinical scenarios, ranging from mild features to multi-organ dysfunction and mortality. However, this novel entity has a heterogenicity of data regarding prognostic factors associated with severe outcomes. The present study aimed to identify independent predictors for severity by using multivariate regression models. A total of 391 patients (255 boys and 136 girls) were admitted to Vietnam National Children's Hospital from January 2022 to June 2023. The median age was 85 (range: 2-188) months, and only 12 (3.1%) patients had comorbidities. 161 (41.2%) patients required PICU admission, and the median PICU LOS was 4 (2-7) days. We observed independent factors related to PICU admission, including CRP ≥ 50 (mg/L) (OR 2.52, 95% CI 1.39-4.56, p = 0.002), albumin ≤ 30 (g/L) (OR 3.18, 95% CI 1.63-6.02, p = 0.001), absolute lymphocyte count ≤ 2 (× 109/L) (OR 2.18, 95% CI 1.29-3.71, p = 0.004), ferritin ≥ 300 (ng/mL) (OR 2.35, 95% CI 1.38-4.01), p = 0.002), and LVEF < 60 (%) (OR 2.48, 95% CI 1.28-4.78, p = 0.007). Shock developed in 140 (35.8%) patients, especially for those decreased absolute lymphocyte ≤ 2 (× 109/L) (OR 2.48, 95% CI 1.10-5.61, p = 0.029), albumin ≤ 30 (g/L) (OR 2.53, 95% CI 1.22-5.24, p = 0.013), or LVEF < 60 (%) (OR 2.24, 95% CI 1.12-4.51, p = 0.022). In conclusion, our study emphasized that absolute lymphocyte count, serum albumin, CRP, and LVEF were independent predictors for MIS-C severity. Further well-designed investigations are required to validate their efficacy in predicting MIS-C severe cases, especially compared to other parameters. As MIS-C is a new entity and severe courses may progress aggressively, identifying high-risk patients optimizes clinicians' follow-up and management to improve disease outcomes.
Collapse
Affiliation(s)
- Dien M Tran
- Surgical Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam
- Department of Pediatrics, Faculty of Medicine & Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Dem V Pham
- Department of Pediatrics, Faculty of Medicine & Pharmacy, Vietnam National University, Hanoi, Vietnam
| | - Tung V Cao
- Cardiovascular Center, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Canh N Hoang
- Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Ha T T Nguyen
- Department of Immunology, Allergy, and Rheumatology, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Giang D Nguyen
- Department of Immunology, Allergy, and Rheumatology, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Cuong N Le
- Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Quan Q Thieu
- Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Tuan A Ta
- Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Hung V Dau
- Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Chi Q Le
- Department of Immunology, Allergy, and Rheumatology, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Quang H Le
- Cardiovascular Center, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Nghiem T Luong
- Department of Hematology, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Mai T Tran
- Department of Biochemistry, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Phu H Nguyen
- Training and Research Institute for Child Health, Vietnam National Children's Hospital, Hanoi, Vietnam
| | - Nhung T Nguyen
- Training and Research Institute for Child Health, Vietnam National Children's Hospital, Hanoi, Vietnam
- Department of Biostatistics, Hanoi University of Public Health, Hanoi, Vietnam
| | - Phuc H Phan
- Pediatric Intensive Care Unit, Vietnam National Children's Hospital, Hanoi, Vietnam.
- Training and Research Institute for Child Health, Vietnam National Children's Hospital, Hanoi, Vietnam.
| |
Collapse
|
3
|
Reyes-Pagcatipunan MG, Isada PMD, Delos Reyes CA. Clinical and Laboratory Profile, Management and Outcome of Pediatric SARS-CoV-2 Infection Admitted at the Philippine General Hospital. ACTA MEDICA PHILIPPINA 2024; 58:14-26. [PMID: 38882922 PMCID: PMC11168954 DOI: 10.47895/amp.v58i7.7717] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Indexed: 06/18/2024]
Abstract
Background The Philippines has recorded over 470,000 COVID-19 cases in children, with over 1,500 deaths during the same period. Although a Philippine online pediatric COVID-19 registry exists, this only relies on passive surveillance. Objectives This study determined the clinical and laboratory profile, risk factors for severe COVID-19, and mortality, management, and outcome of pediatric SARS-CoV-2 patients admitted at the Philippine General Hospital (PGH) from April 2020 to June 2022 to fill in knowledge gaps on the epidemiology of COVID-19 infection in children. Methods This was a retrospective cohort study of pediatric COVID-19 cases admitted at the PGH, a designated COVID referral center during the study period. Demographic and clinical profile, risk factors, comorbidities, laboratory and radiologic findings, management, and outcomes across different disease severity states were gathered by chart review and the data were analyzed using STATA 17. Results There were 448 pediatric patients admitted and diagnosed with COVID-19 during the study period. Most patients belonged to the 1-5-year age group (25.9%), had no known exposure to a COVID-19 case (65.4%), were mild cases (37.3%%), and did not receive any dose of the COVID-19 vaccine (96.7%). The most common presenting symptoms across all disease categories were fever (44.4%), cough (28.6%), and shortness of breath (26.6%). Multisystem inflammatory syndrome in children (MIS-C) presented with fever (100%) and rash (53.9%). The risk factors for severe disease were the presence of a congenital anomaly lung disease, and elevated procalcitonin. Most patients with MIS-C were previously well with no comorbidities. Laboratory findings which were markedly elevated among severe and critical cases were ESR, CRP, D-dimer, LDH, and IL-6. Ferritin, procalcitonin (PCT) and IL-6 were elevated only in severe to critical COVID-19 cases and remained within normal for the other disease categories. As to treatment, asymptomatic, mild, and moderate cases were given supportive medications (zinc, vitamin D, and vitamin C), while investigational drugs particularly corticosteroids, IVIG, and remdesivir, were used in severe cases.Antibiotics were given to 71.7% of patients at the outset. As to the outcomes, 89% recovered, while 8.9% died. The case fatality rate from COVID-19 infection was at 2.2%. Conclusion Admitted pediatric COVID-19 cases are generally mild but admission is due to underlying illness or comorbidities. Those with severe to critical cases have underlying comorbidities and had either progression or complications due to COVID disease. D-dimer, LDH, IL-6, ferritin and procalcitonin were elevated among severe and critical cases which can be utilized as inflammatory markers.
Collapse
Affiliation(s)
- Marimel G Reyes-Pagcatipunan
- Department of Pediatrics, College of Medicine and Philippine General Hospital, University of the Philippines Manila
- National Clinical Trials and Translation Center, University of the Philippines Manila
| | | | - Carmina A Delos Reyes
- Department of Pediatrics, College of Medicine and Philippine General Hospital, University of the Philippines Manila
| |
Collapse
|
4
|
Rudsenske NE, Perkins JB. Assessing severity of COVID-19 and the development of multi system inflammatory syndrome in children (MIS-C) in pediatric patients with atopic disease. Allergy Asthma Proc 2024; 45:92-96. [PMID: 38449015 PMCID: PMC10926182 DOI: 10.2500/aap.2024.45.230087] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 03/08/2024]
Abstract
Background: Research surrounding the coronavirus disease 2019 (COVID-19) pandemic and its impact on patients who are atopic has mainly focused on adults. After the delta variant showed increased rates of COVID-19 in children, the pediatric population needs to be assessed as well. Objective: The objective was to assess and report outcomes in patients with COVID-19 and with and without certain atopic diseases in our patient cohort at the University of Mississippi Medical Center. Methods: We conducted a retrospective review of patients by using a de-identified data base that allows querying via medical claims codes from the University of Mississippi Medical Center's Research Data Warehouse. We searched for patients who were COVID-19 positive and ages 0-21 years from January 1, 2020, to December 31, 2021. We then divided this population into two cohorts: an atopic population and a non-atopic population. The incidence of hospitalizations, intensive care unit (ICU) admissions, death, length of stay, inhaled corticosteroid prescription history, and the incidence of multi-system inflammatory syndrome in children (MIS-C) outcomes in the two populations were collected. Results: There were 5261 patients ages 0-21 years and with confirmed COVID-19. After exclusion criteria were applied, there were 1420 patients in the atopic cohort and 2525 patients in the non-atopic cohort. There were more hospitalizations and a longer length of stay in the atopic population. Mortality was equivalent in the atopic and non-atopic populations. There were more ICU admissions in the atopic population. There were 101 patients total with the diagnosis of MIS-C, and the incidence of MIS-C was similar in the atopic and non-atopic populations. There were more patients who were atopic on inhaled corticosteroid than were the patients who were non-atopic. Conclusion: This study sought to further elucidate whether asthma, atopic dermatitis, and allergic rhinitis in pediatric patients was associated with severe COVID-19. Our study showed increased hospitalizations, length of stay, and intensive care in the atopic population but similar outcomes in mortality and the development of MIS-C. Future longitudinal prospective studies are needed to assess the long-term effects on patient's atopic disease after COVID-19 infection.
Collapse
|
5
|
Izquierdo-Condoy JS, Vásconez-Gonzáles J, Morales-Lapo E, Tello-De-la-Torre A, Naranjo-Lara P, Fernández R, Hidalgo MR, Escobar A, Yépez VH, Díaz AM, Oliva C, Ortiz-Prado E. Beyond the acute phase: a comprehensive literature review of long-term sequelae resulting from infectious diseases. Front Cell Infect Microbiol 2024; 14:1293782. [PMID: 38357446 PMCID: PMC10864624 DOI: 10.3389/fcimb.2024.1293782] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/13/2023] [Accepted: 01/16/2024] [Indexed: 02/16/2024] Open
Abstract
Infectious diseases have consistently served as pivotal influences on numerous civilizations, inducing morbidity, mortality, and consequently redirecting the course of history. Their impact extends far beyond the acute phase, characterized by the majority of symptom presentations, to a multitude of adverse events and sequelae that follow viral, parasitic, fungal, or bacterial infections. In this context, myriad sequelae related to various infectious diseases have been identified, spanning short to long-term durations. Although these sequelae are known to affect thousands of individuals individually, a comprehensive evaluation of all potential long-term effects of infectious diseases has yet to be undertaken. We present a comprehensive literature review delineating the primary sequelae attributable to major infectious diseases, categorized by systems, symptoms, and duration. This compilation serves as a crucial resource, illuminating the long-term ramifications of infectious diseases for healthcare professionals worldwide. Moreover, this review highlights the substantial burden that these sequelae impose on global health and economies, a facet often overshadowed by the predominant focus on the acute phase. Patients are frequently discharged following the resolution of the acute phase, with minimal long-term follow-up to comprehend and address potential sequelae. This emphasizes the pressing need for sustained vigilance, thorough patient monitoring, strategic health management, and rigorous research to understand and mitigate the lasting economic and health impacts of infectious diseases more fully.
Collapse
|
6
|
Patel H, Burgner D, Whittaker E. Multisystem inflammatory syndrome in children: a longitudinal perspective on risk factors and future directions. Pediatr Res 2024; 95:15-17. [PMID: 37667033 DOI: 10.1038/s41390-023-02803-y] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/18/2023] [Accepted: 08/09/2023] [Indexed: 09/06/2023]
Affiliation(s)
- Harsita Patel
- Department of Infectious Disease, Section of Paediatrics, Imperial College, London, UK
| | - David Burgner
- Infection and Immunity Theme, Murdoch Children's Research Institute, Royal Children's Hospital, Parkville, VIC, Australia.
- Department of Paediatrics, The University of Melbourne, Parkville, VIC, Australia.
| | - Elizabeth Whittaker
- Department of Infectious Disease, Section of Paediatrics, Imperial College, London, UK
- Paediatric Infectious Diseases, Imperial College Healthcare NHS Trust, London, UK
| |
Collapse
|
7
|
Collier AF, Schaefer KR, Uddin A, Noonan C, Dillard DA, Son-Stone L, Manson SM, Buchwald D, MacLehose R. COVID-19 vaccination in urban American Indian and Alaska Native children: Parental characteristics, beliefs and attitudes associated with vaccine acceptance. Vaccine X 2023; 15:100406. [PMID: 38058791 PMCID: PMC10696120 DOI: 10.1016/j.jvacx.2023.100406] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/06/2023] [Revised: 11/07/2023] [Accepted: 11/12/2023] [Indexed: 12/08/2023] Open
Abstract
Background Little is known about vaccination rates for American Indian and Alaska Native (AI/AN) parents and their children, or parental decisions in this regard. Improving vaccination rates is a serious concern due to the disproportionate incidence and morbidity of COVID-19 in AI/AN people. Purpose Our goal was to describe urban AI/AN parental attributes associated with COVID-19 vaccination of their children. Methods Survey participants (n = 572) were ≥18 years of age, had children ≥5 years of age, AI/AN, and seen at one of six urban health organizations serving primarily AI/AN people within the prior year. They were asked about gender, age, education, marital status, perceived stress, trauma history, whether they had received the COVID-19 vaccine, tested positive for COVID-19 in the past, and if their child was vaccinated. They were also asked about 16 vaccine hesitancy reasons. Results Parental vaccination rate was 82%, with 59% of their children vaccinated. Parents who vaccinated their children were older, had higher education, lower stress and trauma, and were more likely to be vaccinated compared to parents who did not vaccinate their children. Forty-two percent of parents indicated they would likely vaccinate their unvaccinated child in the future. Sixteen vaccine hesitancy reasons revealed four factors: distrust, inconvenience, lack of concern about the pandemic, and AI/AN concerns. Parents who had no plans to vaccinate their children had the highest vaccine distrust and lack of concern about the pandemic. Parents with greater vaccine distrust and AI/AN specific concern reported significantly greater trauma history and higher levels of education. Conclusion Even though vaccination rates for AI/AN parents and children are high, the consequences of COVID-19 for AI/AN people are more severe than for other US populations. Providers should use trauma-informed, trust-building and culturally competent communication when discussing choices about vaccination with AI/AN parents.
Collapse
Affiliation(s)
| | | | - Azhar Uddin
- Institute for Research and Education to Advance Community Health, Elson S Floyd College of Medicine, Washington State University, United States
| | - Carolyn Noonan
- Institute for Research and Education to Advance Community Health, Elson S Floyd College of Medicine, Washington State University, United States
| | | | - Linda Son-Stone
- First Nations Community Healthsource, Albuquerque, NM, United States
| | - Spero M. Manson
- Centers for American Indian and Alaska Native Health, University of Colorado Anschutz Medical Campus, United States
| | - Dedra Buchwald
- Institute for Research and Education to Advance Community Health, Elson S Floyd College of Medicine, Washington State University, United States
| | - Richard MacLehose
- Department of Epidemiology and Community Health, University of Minnesota, School of Public Health, United States
| | | |
Collapse
|
8
|
Khoury M, Harahsheh AS, Raghuveer G, Dahdah N, Lee S, Fabi M, Selamet Tierney ES, Portman MA, Choueiter NF, Elias M, Thacker D, Dallaire F, Orr WB, Harris TH, Norozi K, Truong DT, Khare M, Szmuszkovicz JR, Pagano JJ, Manlhiot C, Farid P, McCrindle BW. Obesity and Outcomes of Kawasaki Disease and COVID-19-Related Multisystem Inflammatory Syndrome in Children. JAMA Netw Open 2023; 6:e2346829. [PMID: 38064213 PMCID: PMC10709775 DOI: 10.1001/jamanetworkopen.2023.46829] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2023] [Accepted: 10/23/2023] [Indexed: 12/18/2023] Open
Abstract
Importance Obesity may affect the clinical course of Kawasaki disease (KD) in children and multisystem inflammatory syndrome in children (MIS-C) associated with COVID-19. Objective To compare the prevalence of obesity and associations with clinical outcomes in patients with KD or MIS-C. Design, Setting, and Participants In this cohort study, analysis of International Kawasaki Disease Registry (IKDR) data on contemporaneous patients was conducted between January 1, 2020, and July 31, 2022 (42 sites, 8 countries). Patients with MIS-C (defined by Centers for Disease Control and Prevention criteria) and patients with KD (defined by American Heart Association criteria) were included. Patients with KD who had evidence of a recent COVID-19 infection or missing or unknown COVID-19 status were excluded. Main Outcomes and Measures Patient demographic characteristics, clinical features, disease course, and outcome variables were collected from the IKDR data set. Using body mass index (BMI)/weight z score percentile equivalents, patient weight was categorized as normal weight (BMI <85th percentile), overweight (BMI ≥85th to <95th percentile), and obese (BMI ≥95th percentile). The association between adiposity category and clinical features and outcomes was determined separately for KD and MIS-C patient groups. Results Of 1767 children, 338 with KD (median age, 2.5 [IQR, 1.2-5.0] years; 60.4% male) and 1429 with MIS-C (median age, 8.7 [IQR, 5.3-12.4] years; 61.4% male) were contemporaneously included in the study. For patients with MIS-C vs KD, the prevalence of overweight (17.1% vs 11.5%) and obesity (23.7% vs 11.5%) was significantly higher (P < .001), with significantly higher adiposity z scores, even after adjustment for age, sex, and race and ethnicity. For patients with KD, apart from intensive care unit admission rate, adiposity category was not associated with laboratory test features or outcomes. For patients with MIS-C, higher adiposity category was associated with worse laboratory test values and outcomes, including a greater likelihood of shock, intensive care unit admission and inotrope requirement, and increased inflammatory markers, creatinine levels, and alanine aminotransferase levels. Adiposity category was not associated with coronary artery abnormalities for either MIS-C or KD. Conclusions and Relevance In this international cohort study, obesity was more prevalent for patients with MIS-C vs KD, and associated with more severe presentation, laboratory test features, and outcomes. These findings suggest that obesity as a comorbid factor should be considered at the clinical presentation in children with MIS-C.
Collapse
Affiliation(s)
- Michael Khoury
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Ashraf S Harahsheh
- Children's National Hospital, The George Washington University School of Medicine & Health Sciences, Washington, DC
| | | | - Nagib Dahdah
- Division of Pediatric Cardiology, CHU Ste-Justine, University of Montreal, Montreal, Quebec, Canada
| | - Simon Lee
- The Heart Center at Nationwide Children's Hospital, Columbus, Ohio
| | - Marianna Fabi
- Pediatric Emergency Unit, IRCCS Azienda Ospedaliero Universitaria di Bologna, Bologna, Italy
| | | | | | - Nadine F Choueiter
- Children's Hospital at Montefiore, Albert Einstein College of Medicine, Bronx, New York
| | - Matthew Elias
- Children's Hospital of Philadelphia, Philadelphia, Pennsylvania
| | | | - Frédéric Dallaire
- Department of Pediatrics, Universite de Sherbrooke, and Centre de Recherche du Centre Hospitalier Universitaire de Sherbrooke, Sherbrooke, Quebec, Canada
| | - William B Orr
- Division of Pediatric Cardiology, Department of Pediatrics, Washington University School of Medicine, St Louis, Missouri
| | - Tyler H Harris
- UPMC Children's Hospital of Pittsburgh, Pittsburgh, Pennsylvania
| | - Kambiz Norozi
- Department of Pediatrics, Pediatric Cardiology, Western University, London, Ontario, Canada
| | | | - Manaswitha Khare
- University of California San Diego/Rady Children's Hospital San Diego
| | | | - Joseph J Pagano
- Division of Pediatric Cardiology, Department of Pediatrics, University of Alberta, Edmonton, Alberta, Canada
| | - Cedric Manlhiot
- Blalock-Taussig-Thomas Congenital Heart Center at Johns Hopkins University, Baltimore, Maryland
| | - Pedrom Farid
- Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| | - Brian W McCrindle
- Labatt Family Heart Centre, The Hospital for Sick Children, Department of Pediatrics, University of Toronto, Toronto, Ontario, Canada
| |
Collapse
|
9
|
Tulling AJ, Lugthart G, Mooij MG, Brackel CLH, Terheggen-Lagro SWJ, Oostenbrink R, Buysse CMP, Hashimoto S, Armbrust W, Bannier MAGE, Bekhof J, van Gameren-Oosterom HB, Hendriks H, van Houten MA, van der Linden JW, Lebon A, van Onzenoort-Bokken L, Tramper-Stranders GA, van Veen M, von Asmuth EGJ, Buddingh EP. Severe Pediatric COVID-19 and Multisystem Inflammatory Syndrome in Children From Wild-type to Population Immunity: A Prospective Multicenter Cohort Study With Real-time Reporting. Pediatr Infect Dis J 2023; 42:1077-1085. [PMID: 37823702 PMCID: PMC10629607 DOI: 10.1097/inf.0000000000004098] [Citation(s) in RCA: 4] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/21/2023] [Indexed: 10/13/2023]
Abstract
BACKGROUND SARS-CoV-2 variant evolution and increasing immunity altered the impact of pediatric SARS-CoV-2 infection. Public health decision-making relies on accurate and timely reporting of clinical data. METHODS This international hospital-based multicenter, prospective cohort study with real-time reporting was active from March 2020 to December 2022. We evaluated longitudinal incident rates and risk factors for disease severity. RESULTS We included 564 hospitalized children with acute COVID-19 (n = 375) or multisystem inflammatory syndrome in children (n = 189) from the Netherlands, Curaçao and Surinam. In COVID-19, 134/375 patients (36%) needed supplemental oxygen therapy and 35 (9.3%) required intensive care treatment. Age above 12 years and preexisting pulmonary conditions were predictors for severe COVID-19. During omicron, hospitalized children had milder disease. During population immunity, the incidence rate of pediatric COVID-19 infection declined for older children but was stable for children below 1 year. The incidence rate of multisystem inflammatory syndrome in children was highest during the delta wave and has decreased rapidly since omicron emerged. Real-time reporting of our data impacted national pediatric SARS-CoV-2 vaccination- and booster-policies. CONCLUSIONS Our data supports the notion that similar to adults, prior immunity protects against severe sequelae of SARS-CoV-2 infections in children. Real-time reporting of accurate and high-quality data is feasible and impacts clinical and public health decision-making. The reporting framework of our consortium is readily accessible for future SARS-CoV-2 waves and other emerging infections.
Collapse
Affiliation(s)
- Adam J. Tulling
- From the Department of Pediatrics, Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, the Netherlands
| | - Gertjan Lugthart
- From the Department of Pediatrics, Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, the Netherlands
| | - Miriam G. Mooij
- Department of Pediatric Nephrology, Sophia Children’s Hospital, Erasmus MC, Rotterdam, the Netherlands
| | | | - Suzanne W. J. Terheggen-Lagro
- Department of Pediatric Pulmonology, Emma Children’s Hospital, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Rianne Oostenbrink
- Department of General Pediatrics, Sophia Children’s Hospital, Erasmus MC, Rotterdam, the Netherlands
| | - Corinne M. P. Buysse
- Department of Pediatric Intensive Care, Sophia Children’s Hospital, Erasmus MC, Rotterdam, the Netherlands
| | - Simone Hashimoto
- Department of Pediatric Pulmonology, Emma Children’s Hospital, Amsterdam University Medical Center, Amsterdam, the Netherlands
| | - Wineke Armbrust
- Department of Pediatric Rheumatology, University Medical Center Groningen, Groningen, the Netherlands
| | | | - Jolita Bekhof
- Department of Pediatrics, Isala Hospital, Zwolle, the Netherlands
| | | | - Han Hendriks
- Department of Pediatrics, Zuyderland Medical Center, Heerlen, the Netherlands
| | | | | | - Ankie Lebon
- Department of Pediatrics, Albert Schweitzer Hospital, Dordrecht, the Netherlands
| | | | | | - Mirjam van Veen
- Department of Pediatrics, Juliana Children’s Hospital, Hagaziekenhuis, the Hague, the Netherlands
| | - Erik G. J. von Asmuth
- From the Department of Pediatrics, Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, the Netherlands
| | - Emilie P. Buddingh
- From the Department of Pediatrics, Willem-Alexander Children’s Hospital, Leiden University Medical Center, Leiden, the Netherlands
| |
Collapse
|
10
|
Scarduelli L, De Guillebon De Resnes JM, Ducreux D, Bernardor J, Afanetti M, Dupont A, Barthelemy S, Gondon E, Leporati J, Giovannini-Chami L, Moceri P. Cardiac manifestations of MIS-C: cardiac magnetic resonance and speckle-tracking data. Front Cardiovasc Med 2023; 10:1288176. [PMID: 38028482 PMCID: PMC10657844 DOI: 10.3389/fcvm.2023.1288176] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/03/2023] [Accepted: 10/09/2023] [Indexed: 12/01/2023] Open
Abstract
Background Cardiac involvement is central in MIS-C and represents the main cause of morbidity. In this study, we aimed to assess myocardial damage in patients with MIS-C using cardiac magnetic resonance (CMR) during the acute phase, as well as left ventricular and atrial longitudinal strain on admission, at discharge, and after 3 months. Methods We performed a single-center prospective cohort study and case-control study. Between September 2020 and February 2022, we enrolled 39 patients hospitalized for MIS-C at our center. We performed left ventricular and atrial longitudinal 2D strain analysis on admission and during follow-up; echocardiographic data were compared to a matched control population. Patients above 4 years old with increased troponin underwent CMR. Results Of 24 patients (mean age: 8.2 ± 4.9 years) who underwent CMR, 14 (58%) presented myocardial edema and 6 (25%) late gadolinium enhancement (LGE). LGE was associated with older age (p < 0.01), increased BMI (p = 0.03), increased ferritin levels (p < 0.001), lower left ventricular (LV) ejection fraction (p < 0.001), LV longitudinal strain (p = 0.004), left atrial (LA) strain (p = 0.05), and prolonged hospital stay (p = 0.02). On admission, LV ejection fraction, LV longitudinal strain, and LA strain were impaired, but each improved gradually over time; LVEF was the fastest to recover, while global LV longitudinal strain was still impaired as compared to controls after 3 months (p = 0.01). Conclusion Our study demonstrates that myocardial injury is present in a quarter of MIS-C patients, and impaired LA and LV myocardial deformation persist for at least several weeks after the acute phase. CMR and LV/LA strain could help us to individualize follow-up of MIS-C patients.
Collapse
Affiliation(s)
- Lorenzo Scarduelli
- Servicede Pédiatrie, Hôpitaux Pédiatriques de Nice, CHU Lenval, Nice, France
- UR2CA, Faculté de Médecine, Equipe CARRES, Université Côte d’Azur, Nice, France
| | | | - Dorothée Ducreux
- Service de Radiologie, Centre Hospitalier Universitaire de Nice, Nice, France
| | - Julie Bernardor
- Servicede Pédiatrie, Hôpitaux Pédiatriques de Nice, CHU Lenval, Nice, France
- Faculté de Médecine, Université Côte d’Azur, Nice, France
| | - Mickael Afanetti
- Servicede Pédiatrie, Hôpitaux Pédiatriques de Nice, CHU Lenval, Nice, France
| | - Audrey Dupont
- Servicede Pédiatrie, Hôpitaux Pédiatriques de Nice, CHU Lenval, Nice, France
| | | | - Emmanuelle Gondon
- Servicede Pédiatrie, Hôpitaux Pédiatriques de Nice, CHU Lenval, Nice, France
| | - Julien Leporati
- Servicede Pédiatrie, Hôpitaux Pédiatriques de Nice, CHU Lenval, Nice, France
| | - Lisa Giovannini-Chami
- Servicede Pédiatrie, Hôpitaux Pédiatriques de Nice, CHU Lenval, Nice, France
- Faculté de Médecine, Université Côte d’Azur, Nice, France
| | - Pamela Moceri
- UR2CA, Faculté de Médecine, Equipe CARRES, Université Côte d’Azur, Nice, France
- Faculté de Médecine, Université Côte d’Azur, Nice, France
- Service de Cardiologie, Centre Hospitalier Universitaire de Nice, Nice, France
| |
Collapse
|
11
|
Elsaid M, Nune A, Hesham D, Fouad FM, Hassan H, Hamouda H, Sherif H, Abdelwahab MM, Hegazi N, El-Rahman YA. Multisystem Inflammatory Syndrome (MIS) following SARS-CoV-2 vaccinations; a systematic review. Trop Dis Travel Med Vaccines 2023; 9:19. [PMID: 37925466 PMCID: PMC10625711 DOI: 10.1186/s40794-023-00204-x] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/11/2023] [Accepted: 07/29/2023] [Indexed: 11/06/2023] Open
Abstract
BACKGROUND Although SARS-CoV-2 vaccines are generally safe, there are growing concerns about their link to a potentially life-threatening multi-system inflammatory syndrome following vaccination (MIS-V). We conducted this systematic review to elucidate the prevalence of MIS, severity, treatment, and outcomes following SARS-CoV-2 vaccination. METHODS We searched PubMed, Scopus, ScienceDirect, Google Scholar, Virtual Health Library (VHL), Cochrane Library, and Web of Science databases for articles and case reports about MIS-V. We performed a qualitative analysis of individual cases from the included studies. RESULTS Of the 1366 studies identified by database search, we retrieved twenty-six case reports and two cohort studies. We analyzed the data of 37 individual cases extracted from 27 articles. The average age of the cases included in this review was 18 (1-67) years, with the most being male (M: F 3.1:1). Of the 37 included cases, the cardiovascular system was the most affected system by MIS (36, 97.3%), followed by the gastrointestinal tract (32, 86.5%). CONCLUSION MIS after SARS-CoV-2 vaccinations can be fatal, but the incidence is low. Prompt recognition of MIS and ruling out the mimickers are critical in the patient's early recovery.
Collapse
Affiliation(s)
- Mohamed Elsaid
- Faculty of Medicine, 6Th of October, Misr University for Science and Technology, Giza, Egypt.
- Medical Research Platform, Giza, Egypt.
| | - Arvind Nune
- Department of Rheumatology and General Medicine, Southport and Ormskirk Hospital NHS Trust, Southport, UK.
| | - Deyaa Hesham
- Medical Research Platform, Giza, Egypt
- Faculty of Pharmacy, Ain Shams University, Cairo, Egypt
| | - Fatma Mohamed Fouad
- Medical Research Platform, Giza, Egypt
- Faculty of Science, Cairo University, Giza, Egypt
- Biology Department, College of Science, Sultan Qaboos University, Muscat, Oman
| | - Hamsa Hassan
- Medical Research Platform, Giza, Egypt
- Faculty of Pharmacy, Mansoura University, Mansoura, Egypt
| | - Heba Hamouda
- Medical Research Platform, Giza, Egypt
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Huda Sherif
- Medical Research Platform, Giza, Egypt
- Faculty of Medicine, Menoufia University, Menoufia, Egypt
| | - Maya Magdy Abdelwahab
- Medical Research Platform, Giza, Egypt
- Faculty of Medicine, Helwan University, Cairo, Egypt
| | - Nourelhoda Hegazi
- Medical Research Platform, Giza, Egypt
- Faculty of Medicine, Alexandria University, Alexandria, Egypt
| | - Yasmena Abd El-Rahman
- Medical Research Platform, Giza, Egypt
- Faculty of Medicine, Portsaid University, Portsaid, Egypt
| |
Collapse
|
12
|
Fröhlich F, Gronwald B, Bay J, Simon A, Poryo M, Geisel J, Tegethoff SA, Last K, Rissland J, Smola S, Becker SL, Zemlin M, Meyer S, Papan C. Expression of TRAIL, IP-10, and CRP in children with suspected COVID-19 and real-life impact of a computational signature on clinical decision-making: a prospective cohort study. Infection 2023; 51:1349-1356. [PMID: 36757525 PMCID: PMC9910257 DOI: 10.1007/s15010-023-01993-1] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/02/2022] [Accepted: 01/28/2023] [Indexed: 02/10/2023]
Abstract
PURPOSE We evaluated the host-response marker score "BV" and its components TRAIL, IP-10, and CRP in SARS-CoV-2 positive children, and estimated the potential impact on clinical decision-making. METHODS We prospectively analyzed levels of TRAIL, IP-10, CRP, and the BV score, in children with suspected COVID-19. Classification of infectious etiology was performed by an expert panel. We used a 5-point-questionnaire to evaluate the intention to treat with antibiotics before and after receiving test results. RESULTS We screened 111 children, of whom 6 (5.4%) were positive for SARS-CoV-2. A total of 53 children were included for the exploratory analysis. Median age was 3.1 years (interquartile range [IQR] 1.3-4.3), and 54.7% (n = 29) were girls. A viral and a bacterial biomarker pattern was found in 27/53 (50.9%) and 15/53 (28.3%), respectively. BV scores differed between COVID-19, children with other viral infections, and children with bacterial infections (medians 29.5 vs. 9 vs. 66; p = 0.0006). Similarly, median TRAIL levels were different (65.5 vs. 110 vs. 78; p = 0.037). We found no differences in IP-10 levels (555 vs. 504 vs. 285; p = 0.22). We found a concordance between physicians' "unlikely intention to treat" children with a viral test result in most cases (n = 19/24, 79.2%). When physicians expressed a "likely intention to treat" (n = 15), BV test revealed 5 bacterial, viral, and equivocal scores each. Antibiotics were withheld in three cases (20%). Overall, 27/42 (64%) of pediatricians appraised the BV test positively, and considered it helpful in clinical practice. CONCLUSION Host-response based categorization of infectious diseases might help to overcome diagnostic uncertainty, support clinical decision-making and reduce unnecessary antibiotic treatment.
Collapse
Affiliation(s)
- Franziska Fröhlich
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Strasse, Building 43, Homburg, Germany
- Department of General Pediatrics and Neonatology, Saarland University Hospital, Homburg, Germany
| | - Benjamin Gronwald
- Department of General Pediatrics and Neonatology, Saarland University Hospital, Homburg, Germany
| | - Johannes Bay
- Department of General Pediatrics and Neonatology, Saarland University Hospital, Homburg, Germany
| | - Arne Simon
- Department of Pediatric Hematology and Oncology, Saarland University Hospital, Homburg, Germany
| | - Martin Poryo
- Department of Pediatric Cardiology, Saarland University Hospital, Homburg, Germany
| | - Jürgen Geisel
- Department of Clinical Chemistry and Laboratory Medicine, Saarland University Medical Centre, Saarland University Hospital, Homburg, Germany
| | - Sina A Tegethoff
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Strasse, Building 43, Homburg, Germany
| | - Katharina Last
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Strasse, Building 43, Homburg, Germany
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany
| | - Jürgen Rissland
- Institute of Virology, Saarland University Medical Center, Homburg, Germany
| | - Sigrun Smola
- Institute of Virology, Saarland University Medical Center, Homburg, Germany
- Helmholtz Center for Infection Research (HZI), Helmholtz Institute for Pharmaceutical Research Saarland (HIPS), Saarland University Campus, Saarbrücken, Germany
| | - Sören L Becker
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Strasse, Building 43, Homburg, Germany
| | - Michael Zemlin
- Department of General Pediatrics and Neonatology, Saarland University Hospital, Homburg, Germany
| | - Sascha Meyer
- Department of General Pediatrics and Neonatology, Saarland University Hospital, Homburg, Germany
| | - Cihan Papan
- Center for Infectious Diseases, Institute of Medical Microbiology and Hygiene, Saarland University, Kirrberger Strasse, Building 43, Homburg, Germany.
- Institute for Hygiene and Public Health, University Hospital Bonn, Bonn, Germany.
| |
Collapse
|
13
|
Tonge JJ, Stevens O, Dawson J, Hawley D, Kerrison C, Krone N, Maltby SL, McMahon AM, Shackley F, Talekar R, Gonzalez-Martinez C, Lawrence N. Assessing the Response of Biomarkers to Anti-Inflammatory Medications in PIMS-TS by Longitudinal Multilevel Modeling: Real-World Data from a UK Tertiary Center. PEDIATRIC ALLERGY, IMMUNOLOGY, AND PULMONOLOGY 2023; 36:94-103. [PMID: 37433192 DOI: 10.1089/ped.2023.0024] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 07/13/2023]
Abstract
Background: Pediatric inflammatory multisystem syndrome temporarily associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection (PIMS-TS) is an acute complication of previous SARS-CoV-2 exposure. The relationship between inflammatory markers and anti-inflammatory medication in PIMS-TS is unknown. We retrospectively investigated the relationship between demographics, biomarkers, treatment, and length of stay (LOS) in this novel disease. Methods: We reviewed the case notes and blood tests of all patients who met the Royal College of Paediatrics and Child Health diagnostic criteria for PIMS-TS at a large tertiary center in the United Kingdom. Biomarker trajectories were modeled using log linear mixed effects, and factors affecting LOS in hospital were evaluated using multiple regression. Results: Between March 2020 and May 2022, a total of 56 patients attended Sheffield Children's Hospital with PIMS-TS, 70% male. Mean age was 7.4 ± 3.7 years and mean LOS 8.7 ± 4.5 days with 50% requiring intensive care and 20% requiring inotropes. Older males had shorter LOS than younger males (P = 0.04), not seen in females. Treatment included intravenous glucocorticoids in 93%, intravenous immunoglobulins (IVIG) in 77%, Anakinra in 11%, and infliximab in 1.8%. Biomarkers correlated poorly with trajectories that peaked at different times. C-reactive protein peaked first after median 1.3 days postadmission; while LFT's and neutrophils peaked after 3 days. Age had a large effect on some biomarkers, with older children having larger troponin and ferritin, and lower lymphocytes and platelets. Cumulative dose of glucocorticoids and IVIG had a statistically significant effect on some biomarkers, but effect size was small. Conclusions: The heterogenous nature of PIMS-TS highlights the importance of a multidisciplinary approach. Worse inflammatory markers in older children within our cohort may be an indication of a different disease process occurring at different ages. Future work to investigate the association between age and troponin and ferritin in hyperinflammatory states is warranted.
Collapse
Affiliation(s)
- Joseph J Tonge
- Academic Unit of Medical Education, University of Sheffield, Sheffield, United Kingdom
| | - Olivia Stevens
- Academic Unit of Medical Education, University of Sheffield, Sheffield, United Kingdom
| | - Jeremy Dawson
- School of Health and Related Research (ScHARR), University of Sheffield, Sheffield, United Kingdom
- Management School, University of Sheffield, Sheffield, United Kingdom
| | - Daniel Hawley
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, United Kingdom
| | - Caroline Kerrison
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, United Kingdom
| | - Nils Krone
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, United Kingdom
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| | - Sarah L Maltby
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, United Kingdom
| | - Anne-Marie McMahon
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, United Kingdom
| | - Fiona Shackley
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, United Kingdom
| | - Rupa Talekar
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, United Kingdom
| | | | - Neil Lawrence
- Sheffield Children's Hospital NHS Foundation Trust, Sheffield, United Kingdom
- Department of Oncology and Metabolism, University of Sheffield, Sheffield, United Kingdom
| |
Collapse
|
14
|
Roge I, Kivite-Urtane A, Smane L, Meiere A, Klavina L, Barzdina E, Pavare J. Short- and mid-term outcomes of multisystem inflammatory syndrome in children: a longitudinal prospective single-center cohort study. Front Pediatr 2023; 11:1223266. [PMID: 37650048 PMCID: PMC10465300 DOI: 10.3389/fped.2023.1223266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 05/15/2023] [Accepted: 08/02/2023] [Indexed: 09/01/2023] Open
Abstract
Background Multisystem inflammatory syndrome in children (MIS-c) emerged during the coronavirus disease 2019 pandemic and is associated with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). Despite the extensively studied clinical manifestation of acute condition, the short- and long-term effects of MIS-c on children's health are unknown. Methods This was a prospective longitudinal cohort study. Children aged <18 years who met the Centers for Disease Prevention and Control (CDC) diagnostic criteria and who were admitted to the Children's Clinical University Hospital of Latvia (CCUH) between July 1, 2020, and April 15, 2022, were enrolled in the study. An outpatient follow-up program was initiated in July 2020. All children were evaluated at 2 weeks, 2 months (1-3 months), and 6 months (5-7 months) after discharge. The face-to-face interviews comprised four domains as follows: symptom assessment, physical examination, laboratory testing, and cardiological investigation [including electrocardiogram (ECG) and echocardiography (echo)]. Results Overall, 21 patients with MIS-c were enrolled. The median age of the study group was 6 years. At the 2-week follow-up, almost half of the patients (N = 10, 47.6%) reported exercise intolerance with provoked tiredness. Laboratory tests showed a considerable increase in blood cell count, with a near doubling of leukocyte and neutrophil counts and a tripling of thrombocyte levels. However, a decline in the levels of inflammatory and organ-specific markers was observed. Cardiological investigation showed significant improvement with gradual resolution of the acute-phase pathological findings. Within 2 months, improvement in exercise capacity was observed with 5-fold and 2-fold reductions in physical intolerance (N = 2, 9.5%) and physical activity-induced fatigue (N = 5, 23.8%), respectively. Normalization of all blood cell lines was observed, and cardiological investigation showed no persistent changes. At the 6-month visit, further improvement in the children's exercise capacity was observed, and both laboratory and cardiological investigation showed no pathological changes. Conclusions Most persistent symptoms were reported within the first 2 weeks after the acute phase, with decreased physical activity tolerance and activity-induced fatigue as the main features. A positive trend was observed at each follow-up visit as the spectrum of the children's complaints decreased. Furthermore, rapid normalization of laboratory markers and cardiac abnormalities was observed.
Collapse
Affiliation(s)
- Ieva Roge
- Department of Pediatrics, Children’s Clinical University Hospital, Riga Stradins University, Riga, Latvia
| | - Anda Kivite-Urtane
- Department of Public Health and Epidemiology, Institute of Public Health, Riga Stradins University, Riga, Latvia
| | - Liene Smane
- Department of Pediatrics, Children’s Clinical University Hospital, Riga Stradins University, Riga, Latvia
| | - Anija Meiere
- Department of Pediatrics, Children’s Clinical University Hospital, Riga Stradins University, Riga, Latvia
| | - Lizete Klavina
- Department of Pediatrics, Children’s Clinical University Hospital, Riga Stradins University, Riga, Latvia
| | - Elza Barzdina
- Faculty of Medicine, Riga Stradins University, Riga, Latvia
| | - Jana Pavare
- Department of Pediatrics, Children’s Clinical University Hospital, Riga Stradins University, Riga, Latvia
| |
Collapse
|
15
|
Diorio C, Teachey DT, Canna SW. Cytokine Storm Syndromes in Pediatric Patients. THE JOURNAL OF ALLERGY AND CLINICAL IMMUNOLOGY. IN PRACTICE 2023; 11:1636-1644. [PMID: 36990432 DOI: 10.1016/j.jaip.2023.03.033] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 11/29/2022] [Revised: 03/15/2023] [Accepted: 03/16/2023] [Indexed: 03/29/2023]
Abstract
Cytokine storm syndromes (CSS) represent a diverse group of disorders characterized by severe overactivation of the immune system. In the majority of patients, CSS arise from a combination of host factors, including genetic risk and predisposing conditions, and acute triggers such as infections. CSS present differently in adults than in children, who are more likely to present with monogenic forms of these disorders. Individual CSS are rare, but in aggregate represent an important cause of severe illness in both children and adults. We present 3 rare, illustrative cases of CSS in pediatric patients that describe the spectrum of CSS.
Collapse
Affiliation(s)
- Caroline Diorio
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa; Immune Dysregulation Frontier Program, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa.
| | - David T Teachey
- Division of Oncology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa; Immune Dysregulation Frontier Program, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
| | - Scott W Canna
- Immune Dysregulation Frontier Program, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa; Division of Rheumatology, Department of Pediatrics, Children's Hospital of Philadelphia, University of Pennsylvania Perelman School of Medicine, Philadelphia, Pa
| |
Collapse
|
16
|
Shishido Y, Nakamura H, Nakagawa T, Kanou S, Ito T, Kuwana S, Ota C. Incidental Hyperferritinemia in Very Young Infants with Mild Symptoms of COVID-19 Disease. CHILDREN (BASEL, SWITZERLAND) 2023; 10:children10050874. [PMID: 37238422 DOI: 10.3390/children10050874] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/27/2023] [Revised: 04/29/2023] [Accepted: 05/10/2023] [Indexed: 05/28/2023]
Abstract
BACKGROUND The number of children infected with novel coronavirus disease 2019 (COVID-19), caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), has increased during the outbreak of the Omicron strain. Hyperferritinemia has been reported in severe cases of COVID-19, and in children or neonates with multisystem inflammatory syndrome (MIS). Hyperferritinemia is considered to be one of the signs of MIS, but thus far, there have been few summarized reports on it. We retrospectively analyzed four infants less than 3 months of age with SARS-CoV-2 infections treated in our institution during the outbreak of the Omicron strain. RESULTS most patients were in good condition, but hyperferritinemia was observed in all of four cases. CONCLUSIONS Hyperferritinemia can be observed in infantile COVID-19 patients even with mild symptoms. It is necessary to carefully monitor their clinical course and monitor the patients.
Collapse
Affiliation(s)
- Yuka Shishido
- Department of Pediatrics, Japanese Red Cross Ishinomaki Hospital, Ishinomaki 9868522, Japan
| | - Haruhiko Nakamura
- Department of Pediatrics, Japanese Red Cross Ishinomaki Hospital, Ishinomaki 9868522, Japan
- Department of Neurology, Miyagi Children's Hospital, Sendai 9893126, Japan
| | - Tomohiro Nakagawa
- Department of Pediatrics, Tohoku University Hospital, Sendai 9808574, Japan
| | - Shinsuke Kanou
- Department of Pediatrics, Japanese Red Cross Ishinomaki Hospital, Ishinomaki 9868522, Japan
| | - Takeshi Ito
- Department of Pediatrics, Japanese Red Cross Ishinomaki Hospital, Ishinomaki 9868522, Japan
| | - Shota Kuwana
- Department of Pediatrics, Japanese Red Cross Ishinomaki Hospital, Ishinomaki 9868522, Japan
| | - Chiharu Ota
- Department of Pediatrics, Tohoku University Hospital, Sendai 9808574, Japan
- Department of Development and Environmental Medicine, Tohoku University Graduate School of Medicine, Sendai 9808575, Japan
| |
Collapse
|
17
|
Kwan ATH, Al-Kassimi K, Portnoff JS, Tesla M, Hanafimosalman M, Gharibi N, Ni T, Sonfack DJN, Martyniuk J, Arfaie S, Mashayekhi MS, Mofatteh M, Jeremian R, Moscote-Salazar LR, Lee Á, Jawad MY, Guo Z, Ceban F, Teopiz KM, Mansur RB, Ho R, Rosenblat JD, Cao B, Rhee TG, McIntyre RS. Association of SARS-CoV-2 Infection with Neurological Symptoms and Neuroimaging Manifestations in the Pediatric Population: A Systematic Review. RESEARCH SQUARE 2023:rs.3.rs-2653722. [PMID: 36945594 PMCID: PMC10029078 DOI: 10.21203/rs.3.rs-2653722/v1] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 03/23/2023]
Abstract
Background Neurological manifestations have been widely reported in adults with COVID-19, yet the extent of involvement among the pediatric population is currently poorly characterized. The objective of our systematic review is to evaluate the association of SARS-CoV-2 infection with neurological symptoms and neuroimaging manifestations in the pediatric population. Methods A literature search of Cochrane Library; EBSCO CINAHL; Global Index Medicus; OVID AMED, Embase, Medline, PsychINFO; and Scopus was conducted in accordance with the Peer Review of Electronic Search Strategies form (October 1, 2019 to March 15, 2022). Studies were included if they reported (1) COVID-19-associated neurological symptoms and neuroimaging manifestations in individuals aged < 18 years with a confirmed, first SARS-CoV-2 infection and were (2) peer-reviewed. Full-text reviews of 222 retrieved articles were performed, along with subsequent reference searches. Results A total of 843 nonduplicate records were retrieved. Of the 19 identified studies, there were ten retrospective observational studies, seven case series, one case report, and one prospective cohort study. A total of 6,985 individuals were included, where 12.8% of hospitalized patients experienced neurocognitive impairments: MIS-C (24.2%), neuroinflammation (10.1%), and encephalopathy (8.1%) were the most common disorders; headaches (16.8%) and seizures (3.8%) were the most common symptoms. Based on pediatric-specific cohorts, children experienced more drowsiness (7.3% vs. 1.3%) and muscle weakness (7.3% vs. 6.3%) as opposed to adolescents. Agitation or irritability was observed more in children (7.3%) than infants (1.3%). Conclusion Our findings revealed a high prevalence of immune-mediated patterns of disease among COVID-19 positive pediatric patients with neurocognitive abnormalities.
Collapse
Affiliation(s)
| | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | | - Ziji Guo
- Brain and Cognition Discovery Foundation
| | | | | | | | | | | | | | | | | |
Collapse
|
18
|
Ludwikowska KM, Popiel A, Matkowska-Kocjan A, Olbromski MJ, Biela M, Wójcik M, Szenborn F, Wielgos K, Pielka-Markiewicz E, Zaryczański J, Kursa MB, Szenborn L. COVID-19 mRNA BNT162b2 vaccine safety and B-cell and T-cell reactogenicity among children with a history of paediatric multisystem inflammatory syndrome temporally associated with COVID-19 (PIMS-TS) - preliminary study. Vaccine 2023; 41:2289-2299. [PMID: 36870876 PMCID: PMC9977623 DOI: 10.1016/j.vaccine.2023.02.072] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/08/2022] [Revised: 02/20/2023] [Accepted: 02/22/2023] [Indexed: 03/06/2023]
Abstract
To assess the safety of Pfizer-BioNTech COVID-19 mRNA BNT162b2 vaccine (Comirnaty®) among patients with the anamnesis of paediatric inflammatory syndrome temporally associated with COVID-19 (PIMS-TS), we conducted a prospective cohort study of 21 patients with history of PIMS (PIMS group, median age 7.4 years, 71% male) and 71 healthy controls without such an anamnesis (CONTROL group, median age 9.0 years, 39% male) aged 5-18 years. Among them, 85 patients (all PIMS patients and 64 CONTROL patients) completed the two dose schedule of vaccination administered 21 days apart and 7 children in the CONTROL group received a single, age appropriate dose of a COVID-19 mRNA BNT162b2 vaccine during the study period. The frequency and character of reported adverse events (AEs) after each dose and results of flow cytometry (FC) 3 weeks after a second dose were compared between those groups. COVID-19 mRNA BNT162b2 vaccine safety profile was very good and comparable in both groups. No severe AEs were observed. 30% of all patients reported some general AE after any vaccine dose and 46% - some local AE. Frequency of reported AEs did not differ between groups except for local hardening at injection site, more common in PIMS group (20% vs 4% after any vaccine dose, p = 0,02). All AEs were benign, general AEs lasted up to 5 days and localised - up to 6 days after a vaccine dose. COVID-19 mRNA BNT162b2 vaccine did not induce any PIMS-like symptoms in any patient. We did not observe any significant T cells or B cells subset abnormalities in the PIMS group compared to the CONTROL group three weeks after a second dose except for terminally differentiated effector memory T cells that were higher in PIMS group (p < 0.0041). To sum up COVID-19 mRNA BNT162b2 vaccine in children with PIMS-TS was safe. Further studies are required to support our findings.
Collapse
Affiliation(s)
- Kamila M Ludwikowska
- Department of Pediatric Infectious Diseases, Wroclaw Medical University, Ludwika Pasteura 1, 50-367 Wrocław, Poland.
| | - Aneta Popiel
- Department of Pediatric Infectious Diseases, Wroclaw Medical University, Ludwika Pasteura 1, 50-367 Wrocław, Poland; Department of Histology and Embryology, Department of Human Morphology and Embryology, Wroclaw Medical University, Ludwika Pasteura 1, 50-367 Wrocław, Poland
| | - Agnieszka Matkowska-Kocjan
- Department of Pediatric Infectious Diseases, Wroclaw Medical University, Ludwika Pasteura 1, 50-367 Wrocław, Poland
| | - Mateusz J Olbromski
- Department of Histology and Embryology, Department of Human Morphology and Embryology, Wroclaw Medical University, Ludwika Pasteura 1, 50-367 Wrocław, Poland
| | - Mateusz Biela
- Department of Pediatric Infectious Diseases, Wroclaw Medical University, Ludwika Pasteura 1, 50-367 Wrocław, Poland
| | - Marta Wójcik
- Department of Pediatric Infectious Diseases, Wroclaw Medical University, Ludwika Pasteura 1, 50-367 Wrocław, Poland
| | - Filip Szenborn
- Faculty of Electronics, Wroclaw University of Science and Technology, Stanisława Wyspiańskiego 27, 50-370 Wrocław, Poland
| | - Katarzyna Wielgos
- Department of Paediatrics, J. Gromkowski Regional Specialist Hospital in Wroclaw, Koszarowa 5, 51-149 Wroclaw, Poland
| | - Ewa Pielka-Markiewicz
- University Clinical Hospital in Opole Pediatric Ward, Wincentego Witosa 26, 46-020 Opole, Poland
| | - Janusz Zaryczański
- Department of Paediatrics, Institute of Medical Sciences, University of Opole, Wincentego Witosa 26, 46-020 Opole, Poland
| | - Miron B Kursa
- Interdisciplinary Centre for Mathematical and Computational Modelling, University of Warsaw, Pawinskiego 5A, 02-106 Warsaw, Poland
| | - Leszek Szenborn
- Department of Pediatric Infectious Diseases, Wroclaw Medical University, Ludwika Pasteura 1, 50-367 Wrocław, Poland
| |
Collapse
|
19
|
Pino R, Antoñanzas JM, Paredes-Carmona F, Perramon A, Rivière JG, Coma M, Martínez-Mejías A, Ripoll F, López N, Conti R, Sala-Castellví P, Ruiz M, Brio S, García-Lorenzo M, Esteller M, Carreras-Abad C, Herrero-Hernando C, Schneider SO, Gatell A, Aguilar I, Cantero J, Ruiz G, Fenollosa T, Lobato Z, Villalobos P, Mora E, Anton J, Visa-Reñé N, Soler-Palacin P, Calavia O, Esquirol-Herrero C, Guarch-Ibañez B, García-García JJ, Coma E, Fina F, Prats C, Soriano-Arandes A. Multisystem inflammatory syndrome in children and SARS-CoV-2 variants: a two-year ambispective multicentric cohort study in Catalonia, Spain. Eur J Pediatr 2023; 182:1897-1909. [PMID: 36801975 PMCID: PMC9937862 DOI: 10.1007/s00431-023-04862-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 11.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 09/19/2022] [Revised: 02/01/2023] [Accepted: 02/03/2023] [Indexed: 02/20/2023]
Abstract
Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe disease temporarily related to SARS-CoV-2. We aimed to describe the epidemiological, clinical, and laboratory findings of all MIS-C cases diagnosed in children < 18 years old in Catalonia (Spain) to study their trend throughout the pandemic. This was a multicenter ambispective observational cohort study (April 2020-April 2022). Data were obtained from the COVID-19 Catalan surveillance system and from all hospitals in Catalonia. We analyzed MIS-C cases regarding SARS-CoV-2 variants for demographics, symptoms, severity, monthly MIS-C incidence, ratio between MIS-C and accumulated COVID-19 cases, and associated rate ratios (RR). Among 555,848 SARS-CoV-2 infections, 152 children were diagnosed with MIS-C. The monthly MIS-C incidence was 4.1 (95% CI: 3.4-4.8) per 1,000,000 people, and 273 (95% CI: 230-316) per 1,000,000 SARS-CoV-2 infections (i.e., one case per 3,700 SARS-CoV-2 infections). During the Omicron period, the MIS-C RR was 8.2 (95% CI: 5.7-11.7) per 1,000,000 SARS-CoV-2 infections, which was significantly lower (p < 0.001) than that for previous variant periods in all age groups. The median [IQR] age of MIS-C was 8 [4-11] years, 62.5% male, and 80.2% without comorbidities. Common symptoms were gastrointestinal findings (88.2%) and fever > 39 °C (81.6%); nearly 40% had an abnormal echocardiography, and 7% had coronary aneurysm. Clinical manifestations and laboratory data were not different throughout the variant periods (p > 0.05). Conclusion: The RR between MIS-C cases and SARS-CoV-2 infections was significantly lower in the Omicron period for all age groups, including those not vaccinated, suggesting that the variant could be the main factor for this shift in the MISC trend. Regardless of variant type, the patients had similar phenotypes and severity throughout the pandemic. What is Known: • Before our study, only two publications investigated the incidence of MIS-C regarding SARS-CoV-2 variants in Europe, one from Southeast England and another from Denmark. What is New: • To our knowledge, this is the first study investigating MIS-C incidence in Southern Europe, with the ability to recruit all MIS-C cases in a determined area and analyze the rate ratio for MIS-C among SARS-CoV-2 infections throughout variant periods. • We found a lower rate ratio of MISC/infections with SARS-CoV-2 in the Omicron period for all age groups, including those not eligible for vaccination, suggesting that the variant could be the main factor for this shift in the MISC trend.
Collapse
Affiliation(s)
- Rosa Pino
- Paediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Catalonia, Spain
| | - Jesús M Antoñanzas
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Catalonia, Spain
| | | | - Aida Perramon
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Catalonia, Spain
| | - Jacques G Rivière
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig de La Vall d'Hebron, 119-129, 08035, Barcelona, Catalonia, Spain
| | - Maria Coma
- Hospital Universitari Joan XXII, Tarragona, Catalonia, Spain
| | | | - Francesc Ripoll
- Unitat d'Infectologia Pediàtrica de Girona ICS-IAS, Hospital Universitari Josep Trueta, Girona, Catalonia, Spain
| | - Núria López
- Hospital del Mar, Universitat Pompeu Fabra, Barcelona, Catalonia, Spain
| | - Romina Conti
- Consorci Sanitari Parc Taulí, Sabadell, Catalonia, Spain
| | - Pere Sala-Castellví
- Hospital Universitari General de Catalunya, Sant Cugat del Vallés, Barcelona, Catalonia, Spain
| | - Montserrat Ruiz
- Hospital Universitari de Vic, Vic, Barcelona, Catalonia, Spain
| | - Sonia Brio
- Hospital Universitari de La Santa Creu I Sant Pau, Barcelona, Catalonia, Spain
| | | | | | - Clara Carreras-Abad
- Paediatric Infectious Diseases Unit, Hospital Universitari Germans Trias I Pujol, Badalona, Catalonia, Spain
| | - Carlos Herrero-Hernando
- Department of Pediatrics, Hospital de Barcelona, Societat Cooperativa d'Instal·Lacions Assistencials Sanitàries (SCIAS), Barcelona, Catalonia, Spain
| | | | - Anna Gatell
- Equip d'Atenció Primària de Pediatria Garraf, Institut Català de La Salut, Vilanova I La Geltrú, Catalonia, Spain
| | - Isabel Aguilar
- CAP Camps Blancs, Institut Català de La Salut, Sant Boi de Llobregat, Barcelona, Catalonia, Spain
| | - Javier Cantero
- Corporació de Salut del Maresme I La Selva, Barcelona-Girona, Catalonia, Spain
| | - Gloria Ruiz
- Pediatria Dels Pirineus SCCLP, Lleida, Catalonia, Spain
| | | | - Zulema Lobato
- Althaia, Xarxa Assistencial Universitària de Manresa (Fundació Althaia), Catalonia, Barcelona, Spain
| | | | - Emiliano Mora
- Hospital Mútua de Terrassa, Barcelona, Catalonia, Spain
| | - Jordi Anton
- Paediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Catalonia, Spain
| | - Núria Visa-Reñé
- Hospital Universitari Arnau de Vilanova, Lleida, Catalonia, Spain
| | - Pere Soler-Palacin
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig de La Vall d'Hebron, 119-129, 08035, Barcelona, Catalonia, Spain
| | - Olga Calavia
- Hospital Universitari Joan XXII, Tarragona, Catalonia, Spain
| | | | - Borja Guarch-Ibañez
- Unitat d'Infectologia Pediàtrica de Girona ICS-IAS, Hospital Universitari Josep Trueta, Girona, Catalonia, Spain
| | - Juan-José García-García
- Paediatrics Department, Hospital Sant Joan de Déu, Universitat de Barcelona, Esplugues, Barcelona, Catalonia, Spain
| | - Ermengol Coma
- Sistemes d'Informació Dels Serveis d'Atenció Primària (SISAP), Institut Català de La Salut (ICS), Barcelona, Catalonia, Spain
| | - Francesc Fina
- Sistemes d'Informació Dels Serveis d'Atenció Primària (SISAP), Institut Català de La Salut (ICS), Barcelona, Catalonia, Spain
| | - Clara Prats
- Department of Physics, Universitat Politècnica de Catalunya, Barcelona, Catalonia, Spain
| | - Antoni Soriano-Arandes
- Paediatric Infectious Diseases and Immunodeficiencies Unit, Hospital Universitari Vall d'Hebron, Vall d'Hebron Barcelona Hospital Campus, Passeig de La Vall d'Hebron, 119-129, 08035, Barcelona, Catalonia, Spain.
| |
Collapse
|
20
|
Hjelmgren H, Andersson K, Widegren J, Bergman E, Vermé A, Mördrup K, Öhlander M, Bartholdson C. Multi-inflammatory syndrome in children (MIS-C) associated with COVID-19: a nursing perspective experience report from a high-income tertiary paediatric hospital context. Pediatr Rheumatol Online J 2023; 21:5. [PMID: 36653842 PMCID: PMC9845810 DOI: 10.1186/s12969-023-00786-y] [Citation(s) in RCA: 1] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/25/2022] [Accepted: 01/07/2023] [Indexed: 01/20/2023] Open
Abstract
BACKGROUND In the midst of the COVID-19 coronavirus pandemic, a new disease that affects children has arisen called multisystem inflammatory syndrome in children (MIS-C). Several research articles focusing on its medical aspects have been published, but very few have focused on nursing care. The aim of this study was therefore to describe the nursing status of children suffering from MIS-C and the experiences of registered nurses (RNs) in caring for these children in paediatric hospital inpatient care. METHODS The study design includes both quantitative nursing clinical record data and qualitative interview data. Quantitative data from the clinical records were analysed using descriptive statistics. Qualitative data analysis of the interviews was conducted using both deductive and inductive approaches with content analysis. RESULTS In total, 47 clinical records from children with MIS-C were investigated during January-March 2021. The mean age of the children was 8.8 years. Boys were more affected than girls. Challenges in children's nursing status were related to circulation (fever and swelling), nutrition (great thirst and loss of appetite), pain, and psychosocial situations. When caring for children with MIS-C, nurses experienced "frustration over uncertainty of care", "children's illbeing" and "unavoidable procedures". CONCLUSION This study contributes knowledge to the ongoing nursing care of children suffering from MIS-C. The results show many different areas of nursing focus, which challenges nurses and other disciplines within paediatric hospital care. One important factor when caring for these children was the use of a central venous line early in the care process, which improved the quality of care. Moreover, the care of children suffering from MIS-C demands resources and time from healthcare professionals, especially RNs, to meet caring needs and reduce illbeing.
Collapse
Affiliation(s)
- Henrik Hjelmgren
- Department of Women's and Children's Health, Karolinska Institutet, Stockholm, Sweden. .,Highly Specialised Paediatric Medicine and Orthopaedics, Astrid Lindgren's Children's Hospital, Karolinska University Hospital, Stockholm, Sweden.
| | - Karin Andersson
- grid.24381.3c0000 0000 9241 5705Highly Specialised Paediatric Medicine and Orthopaedics, Astrid Lindgren’s Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Jessica Widegren
- grid.24381.3c0000 0000 9241 5705Highly Specialised Paediatric Medicine and Orthopaedics, Astrid Lindgren’s Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Erika Bergman
- grid.24381.3c0000 0000 9241 5705Highly Specialised Paediatric Medicine and Orthopaedics, Astrid Lindgren’s Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Anna Vermé
- grid.4714.60000 0004 1937 0626Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Highly Specialised Paediatric Medicine and Orthopaedics, Astrid Lindgren’s Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Karina Mördrup
- grid.4714.60000 0004 1937 0626Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Highly Specialised Paediatric Medicine and Orthopaedics, Astrid Lindgren’s Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Marcus Öhlander
- grid.24381.3c0000 0000 9241 5705Highly Specialised Paediatric Medicine and Orthopaedics, Astrid Lindgren’s Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| | - Cecilia Bartholdson
- grid.4714.60000 0004 1937 0626Department of Women’s and Children’s Health, Karolinska Institutet, Stockholm, Sweden ,grid.24381.3c0000 0000 9241 5705Highly Specialised Paediatric Medicine and Orthopaedics, Astrid Lindgren’s Children’s Hospital, Karolinska University Hospital, Stockholm, Sweden
| |
Collapse
|
21
|
Ooms C, Mossong J, Vergison A, Biver A, Wagner K, Niel O, Parrish A, Abdelrahman TT, de la Fuente Garcia I. Multisystem inflammatory syndrome in children during the first two years of the COVID-19 pandemic in Luxembourg. Front Pediatr 2023; 11:1141074. [PMID: 37090918 PMCID: PMC10113488 DOI: 10.3389/fped.2023.1141074] [Citation(s) in RCA: 2] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Accepted: 03/06/2023] [Indexed: 04/25/2023] Open
Abstract
Objective Estimate the incidence of multisystem inflammatory syndrome (MIS-C) in children (0-15 years), the role of SARS-CoV-2 variants during the first two years of COVID-19 pandemic in Luxembourg; and describe the demographic, biological and clinical characteristics of the patients. Method Observational retrospective cohort study. Cases between March 2020 and February 2022 were ascertained from the national registry of MIS-C cases by a retrospective review of medical records. Reported SARS-CoV-2 infections were obtained from the national COVID-19 surveillance system. We calculated monthly MIS-C incidence, the ratio between MIS-C and SARS-CoV-2 infections and associated rate ratios by the periods corresponding to the circulation of different variants. Results 18 children were diagnosed with MIS-C among 35,200 reported infections. The incidence rate of MIS-C was 7.2 [95% confidence interval (CI) 4.5-11.4] per 1,000,000 person-months. A higher incidence of MIS-C was observed between September and December 2021, corresponding to the circulation of the Delta variant than during the first year of the pandemic (RR 3.6, 95% CI, 1.1-12.3). The lowest rate of MIS-C per infection was observed during the Omicron (RR 0.17, 95% CI, 0.03-0.82). Median age at diagnosis was 6.5 years. Previously healthy children made up 88% of MIS-C cases, none were vaccinated against SARS-CoV-2. 33% required intensive care. All patients recovered fully. Conclusions MIS-C incidence and MIS-C risk per infection changed significantly over time during the first two years of COVID-19 pandemic. Monitoring of MIS-C incidence in future SARS-CoV-2 waves will be essential to guide public health interventions and vaccination policies for children.
Collapse
Affiliation(s)
- C Ooms
- Clinique Pédiatrique, National Center for Paediatrics, Centre Hospitalier Luxembourg, Luxembourg, Luxembourg
- Department of Paediatrics, Université Catholique de Louvain, Brussels, Belgium
| | - J Mossong
- Health Directorate, Strassen, Luxembourg
| | - A Vergison
- Health Directorate, Strassen, Luxembourg
| | - A Biver
- Clinique Pédiatrique, National Center for Paediatrics, Centre Hospitalier Luxembourg, Luxembourg, Luxembourg
| | - K Wagner
- Clinique Pédiatrique, National Center for Paediatrics, Centre Hospitalier Luxembourg, Luxembourg, Luxembourg
| | - O Niel
- Clinique Pédiatrique, National Center for Paediatrics, Centre Hospitalier Luxembourg, Luxembourg, Luxembourg
| | - A Parrish
- Department of Microbiology, Laboratoire National de Santé, Dudelange, Luxembourg
| | - T T Abdelrahman
- Department of Microbiology, Laboratoire National de Santé, Dudelange, Luxembourg
| | - I de la Fuente Garcia
- Clinique Pédiatrique, National Center for Paediatrics, Centre Hospitalier Luxembourg, Luxembourg, Luxembourg
| |
Collapse
|
22
|
Chan SM. Multisystem inflammatory syndrome in children: A unique manifestation of COVID-19. ANNALS OF THE ACADEMY OF MEDICINE, SINGAPORE 2022. [DOI: 10.47102/annals-acadmedsg.2022397] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Affiliation(s)
- Si Min Chan
- Khoo Teck Puat–National University Children’s Medical Institute, National University Hospital, Singapore
| |
Collapse
|
23
|
Brio S, Verd S, Ramakers J, Sorribes C, Rodríguez-Fanjul X, Díez R. Commentary: Epidemiology, clinical features and prognostic factors of pediatric SARS-CoV-2 infection: Results from an Italian multicenter study. Front Pediatr 2022; 10:1067453. [PMID: 36568421 PMCID: PMC9780656 DOI: 10.3389/fped.2022.1067453] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/11/2022] [Accepted: 10/24/2022] [Indexed: 12/13/2022] Open
Affiliation(s)
- Sonia Brio
- Intensive Care Unit, Department of Paediatrics, Santa Creu I Sant Pau Hospital, Barcelona, Spain
| | - Sergio Verd
- La Vileta Surgery, Paediatric Unit, Balearic Department of Primary Care, Baleares Health Service, Palma de Mallorca, Spain.,TERCIT Cell Therapy Department, Balearic Institute of Medical Research (IdISBa), Palma de Mallorca, Spain
| | - Jan Ramakers
- TERCIT Cell Therapy Department, Balearic Institute of Medical Research (IdISBa), Palma de Mallorca, Spain.,Department of Pediatrics, Son Espases University Hospital, Palma de Mallorca, Spain
| | - Clara Sorribes
- Intensive Care Unit, Department of Pediatrics, Joan XXIII Hospital, Tarragona, Spain
| | - Xavier Rodríguez-Fanjul
- Intensive Care Unit, Department of Paediatrics, Germans Trias i Pujol Hospital, Barcelona, Spain
| | - Ruth Díez
- Department of Pediatrics, Son Espases University Hospital, Palma de Mallorca, Spain
| |
Collapse
|