Current Concepts in Pediatric Critical Care-6: Pediatric COVID-19 Infections & MIS-C: An Update (Hot Topic)

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Video Summary

Dr. Adrienne Randolph reviewed the cases of acute COVID-19 and multisystem inflammatory syndrome in children (MIS-C). She discussed the initial emergence and diagnostic criteria of MIS-C, distinguishing it from acute COVID-19. She also shared current management recommendations and practice, as well as neurologic involvement and vaccine effectiveness. <br /><br />MIS-C was initially reported in Italy and the UK, and later in New York State, with a total of 38 cases initially reported. The diagnostic criteria for MIS-C included fever for at least one day, evidence of inflammation, involvement of at least two organ systems, evidence of SARS-CoV-2 infection, and no alternative microbial cause. There were differences in the definitions between the CDC and World Health Organization, including age and organ system involvement. <br /><br />MIS-C differs from acute COVID-19 in terms of patient characteristics and severity of illness. Most MIS-C patients were previously healthy children, predominantly Hispanic, Latino, and Black children. Cardiovascular involvement was common in MIS-C, with 40% having impaired ejection fraction and aneurysms. Other organ systems, such as the gastrointestinal and hematologic systems, were also involved. Neurologic involvement was common, but mostly transient, although severe cases were reported.<br /><br />Treatment for MIS-C typically involved intravenous immune globulin (IVIG) and steroids, with some patients also receiving other anti-inflammatories and/or anticoagulation. The use of IVIG plus glucocorticoids resulted in more rapid improvement of cardiovascular dysfunction compared to IVIG alone.<br /><br />Vaccination was found to be effective in reducing the risk of severe COVID-19 and MIS-C. Vaccine effectiveness was high for teenagers and infants born to vaccinated mothers. The effectiveness against Delta variant was still evident even several months after vaccination.<br /><br />Dr. Randolph emphasized the need for preparedness in collecting data for future pandemics, particularly in children. Large patient registries, case-control designs, and randomized trials should be utilized to understand the disease, its complications, and the effectiveness of interventions.

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Adrienne G. Randolph, MD, MS, FCCM

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Concept Multisystem Inflammatory Syndrome in Children

Concept Diagnostic Criteria

Concept Acute COVID-19

Concept Clinical Feature

Concept Organ Involvement

Keywords

MIS-C

acute COVID-19

Dr. Adrienne Randolph

vaccine effectiveness

intravenous immune globulin

neurologic involvement

cardiovascular dysfunction

pandemic preparedness

Multisystem Inflammatory Syndrome in Children

Diagnostic Criteria

Acute COVID-19

Clinical Feature

Organ Involvement

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