BACKGROUND AND AIM:Severe Multi Inflammatory Syndrome in Children (MISC) is known to cause high morbidity and mortality. Cardiac dysfunction is the main debilitating organ affected by MISC post COVID 19 infection and often requires the use of ECMO for survival. ECMO service is not widely available in Malaysia. We describe the use of Continuous Renal Replacement Therapy (CRRT) and Plasma Exchange (PLEX) in severe MISC our case series. METHOD:All paediatric patients with MISC from April 2021 to January 2022 in Paediatric High Dependency Unit Hospital Selayang, Malaysia was included. Case definition as per CDC and WHO guideline. Clinical presentation divided to Kawasaki-like, shock, undifferentiated fever-like and severe refractory MISC. Analysis includes length of stay, length of ventilation, inflammatory markers (CRP, ESR, IL-6, IL-1, IL-10), cardiac markers (Trop-I, NT-ProBNP), treatment with IVIG and steroids, CRRT, Plex, morbidity and mortality. RESULTS:Total patients were 25 (age 1month to 17 years). Thirty six percent are school-going age (5years to less than 9 years old), Average length of ICU stay was 5 days (median). Cardiac complications include coronary dilatation (n=3), pericardial effusion (n=4), perivascular cuffing (n=7), IVS dyskinesia (n=2), poor contractility (n=3) and low ejection fraction <55% (n=6). Six required CRRT and 2 required PLEX, with age range from day 24 of life to 11 years. All patient survived with 4 required anti-failure medications upon discharge.CONCLUSIONS: MISC is a newly described disease during the COVID 19 pandemic. Our patients with severe refractory were successfully treated with IVIG, high dose steroids and CRRT and PLEX.

BACKGROUND AND AIM:To analyze some variables related to the length of stay in the Pediatric Intensive Care Unit (PICU) of a cancer center in São Paulo. METHOD:Descriptive, retrospective cross-sectional study of patients admitted to an oncology hospital in São Paulo, between 2015 and 2020. Information was collected from patients' electronic medical records. RESULTS:A total of 580 patients were admitted to the PICU, 51.7% were female with a stay of five days, 42.5% were aged between 0 and 5 years, 54.1% of admissions were through the Unified Health System with a stay of five days. days, 23.6% of patients had a hematological tumor and remained in hospital for 6.5 days, 9.4% of patients died and remained hospitalized for 18.1 days. There was readmission in 9.1% of patients with a mean length of stay of 15.6 days. Of the admissions, 58.6% were clinical with a stay of 7.8 days, 8.7% coming from the hemodynamics department or another hospital with a stay of seven days. The length of stay regarding the cause of respiratory (11%) and cardiovascular (32.5%) hospitalization was five and four days, respectively. When comparing the length of stay with the PIM II, there was a weak relationship between the variables, with a value of 1.4 days. CONCLUSIONS:The variables that influenced the length of stay were the cause of hospitalization, readmission and death. The scarcity of studies in pediatric oncology populations and instruments that better quantify the mortality of this population was highlighted