Management of Multisystem Inflammatory Syndrome in Children Associated With COVID-19: A Survey From the International Kawasaki Disease Registry

被引:43
作者
Elias, Matthew D. [1 ,12 ]
McCrindle, Brian W. [2 ]
Larios, Guillermo [3 ]
Choueiter, Nadine F. [4 ]
Dahdah, Nagib [5 ]
Harahsheh, Ashraf S. [6 ]
Jain, Supriya [7 ]
Manlhiot, Cedric [8 ]
Portman, Michael A. [9 ]
Raghuveer, Geetha [10 ]
Giglia, Therese M. [1 ]
机构
[1] Childrens Hosp Philadelphia, Div Cardiol, Philadelphia, PA USA
[2] Hosp Sick Children, Toronto, ON, Canada
[3] Pontificia Univ Catolica Chile, Div Pediat, Santiago, Chile
[4] Albert Einstein Coll Med, Childrens Hosp Montefiore, Bronx, NY USA
[5] St Justine Univ Hosp Ctr, Div Pediat Cardiol, Montreal, PQ, Canada
[6] George Washington Univ, Sch Med & Hlth Sci, Dept Pediat, Div Cardiol,Childrens Natl Hosp, Washington, DC 20052 USA
[7] New York Med Coll, Div Pediat Cardiol, Maria Fareri Childrens Hosp, Westchester Med Ctr, Valhalla, NY USA
[8] Johns Hopkins Univ, Sch Med, Div Cardiol, Dept Pediat, Baltimore, MD USA
[9] Seattle Childrens Hosp, Seattle, WA USA
[10] Childrens Mercy Hosp, Kansas City, MO USA
[11] Harvard Med Sch, Boston Childrens Hosp, Dept Cardiol, Dept Pediat, Boston, MA 02115 USA
[12] Childrens Hosp Philadelphia, Div Cardiol, 3401 Civ Ctr Blvd, Philadelphia, PA 19104 USA
关键词
INFECTION; EPICENTER; EPIDEMIC;
D O I
10.1016/j.cjco.2020.09.004
中图分类号
R5 [内科学];
学科分类号
1002 ; 100201 ;
摘要
Background: Since April 2020, there have been numerous reports of children presenting with systemic inflammation, often in critical condition, and with evidence of recent infection of severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2). This condition, since defined as the multisystem inflammatory syndrome in children (MIS-C), is assumed to be a delayed immune response to coronavirus disease 2019 (COVID-19), and there are frequently cardiac manifestations of ventricular dysfunction and/or coronary artery dilation.Methods: We surveyed the inpatient MIS-C management approaches of the members of the International Kawasaki Disease Registry across 38 institutions and 11 countries.Results: Among the respondents, 56% reported using immunomodulatory treatment for all MIS-C patients, regardless of presentation. Every respondent reported use of intravenous immunoglobulin (IVIG), including 53% administering IVIG in all patients. Steroids were most often used for patients with severe clinical presentation or lack of response to IVIG, and only a minority used steroids in all patients (14%). Acetylsalicylic acid was frequently used among respondents (91%), including anti-inflammatory and/or antiplatelet dosing. Respondents reported use of prophylactic anticoagulation, especially in patients at higher risk for venous thromboembolism, and therapeutic anticoagulation, particularly for patients with giant coronary artery aneurysms.Conclusions: There is variation in management of MIS-C patients, with suboptimal evidence to assess superiority of the various treatments; evidence-based gaps in knowledge should be addressed through worldwide collaboration to optimize treatment strategies.
引用
收藏
页码:632 / 640
页数:9
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