Objective Although the initial reports of COVID‐19 cases in children described that children were largely protected from severe manifestations, clusters of paediatric cases of severe systemic hyperinflammation and shock related to severe acute respiratory syndrome coronavirus 2 infection began to be reported in the latter half of April 2020. A novel syndrome called “multisystem inflammatory syndrome in children” (MIS‐C) shares common clinical features with other well‐defined syndromes, including Kawasaki disease, toxic shock syndrome and secondary hemophagocytic lymphohistiocytosis/macrophage activation syndrome. Our objective was to develop a protocol for the evaluation, treatment and follow‐up of patients with MIS‐C. Methods The protocol was developed by a multidisciplinary team. We convened a multidisciplinary working group with representation from the departments of paediatric critical care, cardiology, rheumatology, surgery, gastroenterology, haematology, immunology, infectious disease and neurology. Our protocol and recommendations were based on the literature and our experiences with multisystem inflammatory syndrome in children. After an agreement was reached and the protocol was implemented, revisions were made on the basis of expert feedback. Conclusion Children may experience acute cardiac decompensation or other organ system failure due to this severe inflammatory condition. Therefore, patients with severe symptoms of MIS‐C should be managed in a paediatric intensive care setting, as rapid clinical deterioration may occur. Therapeutic approaches for MIS‐C should be tailored depending on the patients’ phenotypes. Plasmapheresis may be useful as a standard treatment to control hypercytokinemia in cases of MIS‐C with severe symptoms. Long‐term follow‐up of patients with cardiac involvement is required to identify any sequelae of MIS‐C.

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Objective The aim of this study was to compare the clinical and laboratory findings in SARS-CoV-2 (COVID-19) with those of other respiratory viruses in critically ill children. Methods It is a single center retrospective descriptive study conducted in a 32-bed pediatric intensive care unit (PICU). Our study was performed in Ankara City Hospital, Ankara, Turkey, between March 1, 2020, and March 1, 2021. Demographic and clinical characteristics of the patients were collected, and we recorded antibiotic use, antiviral treatments, respiratory and extracorporeal supports, PICU stay, and survival rates. Results A total of 202 pediatric patients who tested positive for either COVID-19 or for another respiratory virus (RVP) were included in the study. Seventy-two patients were COVID-19 positive. The median age of COVID-19 positive patients and RVP positive patients was 97 and 17 months, respectively. Hypoxia was much more common in patients with RVP than in COVID-19 patients. Low oxygen saturation in arterial blood (SaO2), increased oxygen saturation index (OSI), and fraction of inspired oxygen (FiO2) needs were more significant in RVP patients than in COVID-19 patients. Respiratory support therapies, such as high-flow nasal cannula (HFNC) and non-invasive ventilation (NIV), were used more frequently in RVP patients than in COVID-19 patients. Conclusion It is important to distinguish between Covid-19 and RVP cases in order to prioritize intensive care needs in these patients. In addition, non-Covid diseases should not be left aside in the pandemic and appropriate care should be provided to them.

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