Management of COVID-19-associated multisystem inflammatory syndrome in children: A comprehensive literature review.

ABSTRACT:

Introduction

The prevalence and severity of COVID-19 is greatly reduced in children, yet some pediatric patients develop a syndrome resembling Kawasaki Disease (KD), termed Multisystem Inflammatory Syndrome in Children (MIS-C). With an estimated incidence of 2/100,000 children, MIS-C is relatively rare, but can be fatal. Clinical features can include fever, hyperinflammatory state, gastrointestinal symptoms, myocardial dysfunction, and shock. The pathogenesis of MIS-C, although yet to be completely elucidated, appears to be distinct from KD in terms of epidemiology, severity, and biochemical signature.

Methods

This comprehensive review searched AMED, EBM Reviews, Embase, Healthstar, MEDLINE, ERIC, and Cochrane for studies that reported treatments and outcomes of MIS-C.

Results

The search strategy yielded 42 papers, from which 15 underwent full-text review (n = 386). A majority of children received intravenous immunoglobulin (77%) and some form of anticoagulation (63%). Steroid use was also common (44%), with immunotherapy used only in severe cases (n = 72). Outcomes reported included PICU admission (77%), need for extracorporeal membrane oxygenation (5%), and mortality (1.3%). Although efficacy of treatments for MIS-C have largely not yet been investigated, we propose close monitoring by a multidisciplinary team, symptomatic treatment (e.g., intravenous immunoglobulin for KD-like symptoms, steroids/immunotherapy for multisystem inflammation), and long-term follow-up.

Conclusion

Although outcomes are largely favorable, management is based on a different disease entity (KD), which may not be appropriate given the likely pathophysiologic divergences. Further research is required to evaluate the effectiveness of current MIS-C treatments and to determine more refined therapies.

SUBMITTER: Kiss A 

PROVIDER: S-EPMC8032479 | biostudies-literature |

REPOSITORIES: biostudies-literature