Multisystem Inflammatory Syndrome in Children: Clinical Features and Management-Intensive Care Experience from a Pediatric Public Hospital in Western India

Lakshmi Shobhavat; Rekha Solomon; Sudha Rao; Isha Bhagat; Sanjay Prabhu; Shakuntala Prabhu; Manoj Chandrakar; Minnie Bodhanwala

doi:10.5005/jp-journals-10071-23658

Multisystem Inflammatory Syndrome in Children: Clinical Features and Management-Intensive Care Experience from a Pediatric Public Hospital in Western India

Indian J Crit Care Med. 2020 Nov;24(11):1089-1094. doi: 10.5005/jp-journals-10071-23658.

Authors

Lakshmi Shobhavat¹, Rekha Solomon¹, Sudha Rao², Isha Bhagat¹, Sanjay Prabhu², Shakuntala Prabhu², Manoj Chandrakar¹, Minnie Bodhanwala²

Affiliations

¹ Department of PICU, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India.
² Department of Pediatrics, Bai Jerbai Wadia Hospital for Children, Mumbai, Maharashtra, India.

Abstract

Background: Multisystem inflammatory syndrome (MIS) associated with severe acute respiratory syndrome coronavirus (SARS-CoV-2) (MIS-C) in children is being increasingly reported across the world.

Materials and methods: Children fulfilling the World Health Organization criteria of MIS-C needing pediatric intensive care unit between April 15 and July 26, 2020 were studied.

Results: There were 21 patients with median age of 7 years [interquartile range (IQR) 1.9-12.1], of which 11 were females. SARS-CoV-2 real-time polymerase chain reaction positive in 8/21 and/or antibody positive 16/21. Fever was present in all patients, and gastrointestinal symptoms being second most frequent (16/21). One child had aplastic anemia, while the rest had no comorbidities. Nearly all presented with shock (n = 20/21) and 90% needed vasoactive drugs with a median Vasoactive Inotropic Score of 40 (IQR 20-95). Thirteen children needed ventilatory support and one needed peritoneal dialysis. Nine children had left ventricular dysfunction and five had dilatation of coronaries on echocardiography. Inflammatory markers C-reactive protein [98 mg/dL (IQR 89-119)], serum ferritin [710 mg/dL (IQR 422-1,609)], and serum interleukin-6 levels [215 ng/L (IQR 43-527)] were uniformly elevated. Eighteen children received pulse methyl-prednisolone, eleven intravenous immunoglobulins, and four tocilizumab. Eighteen children (86%) were discharged home while three died.

Conclusion: In our cohort, MIS-C was seen in previously healthy children with fever, gastrointestinal symptoms, and shock. Early and aggressive management of shock and immune modulation with methyl-prednisolone and intravenous immunoglobulin were used.

How to cite this article: Shobhavat L, Solomon R, Rao S, Bhagat I, Prabhu S, Prabhu S, et al. Multisystem Inflammatory Syndrome in Children: Clinical Features and Management-Intensive Care Experience from a Pediatric Public Hospital in Western India. Indian J Crit Care Med 2020;24(11):1089-1094.

Keywords: Antibody; COVID-19; Intensive care; MIS-C; PICU; PIMS-TS; Refractory shock; SARS-CoV2.