COVID-19 associated Multisystem Inflammatory Syndrome in Children (MIS-C) guidelines; a Western New York approach

Hennon, Teresa; Penque, Michelle; Abdul-Aziz, Rabheh; Alibrahim, Omar; McGreevy, Megan; Prout, Andrew; Schaefer, Beverly A.; Ambrusko, Steven J.; Pastore, John V.; Turkovich, Stephen; Gómez‐Duarte, Oscar G.; Hicar, Mark D.

doi:10.1016/j.ppedcard.2020.101232

Cited by 178 publications

(311 citation statements)

References 17 publications

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“…Based on our review of the literature and diagnostic algorithms that are publicly available, the task force chose to cast a broad net with respect to the evaluation of patients with possible MIS‐C, while simultaneously balancing the need to reduce indiscriminate overtesting and to prevent unnecessary use of resources in the treatment of pediatric patients who have unrelated causes of fever (2,7,8,10,13–16,20,21). To date, there are no clear data indicating the pretest positive predictive or negative predictive probabilities for each clinical symptom or laboratory value in diagnosing MIS‐C.…”

Section: Resultsmentioning

confidence: 99%

American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS–CoV‐2 and Hyperinflammation in Pediatric COVID‐19: Version 1

Henderson

Canna

Friedman

et al. 2020

Arthritis & Rheumatology

426

613

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Objective To provide guidance on the management of multisystem inflammatory syndrome in children (MIS‐C), a condition characterized by fever, inflammation, and multiorgan dysfunction that manifests late in the course of severe acute respiratory syndrome coronavirus 2 (SARS–CoV‐2) infection, and to provide recommendations for children with hyperinflammation during coronavirus disease 2019 (COVID‐19), the acute, infectious phase of SARS–CoV‐2 infection. Methods A multidisciplinary task force was convened by the American College of Rheumatology (ACR) to provide guidance on the management of MIS‐C associated with SARS–CoV‐2 and hyperinflammation in COVID‐19. The task force was composed of 9 pediatric rheumatologists, 2 adult rheumatologists, 2 pediatric cardiologists, 2 pediatric infectious disease specialists, and 1 pediatric critical care physician. Preliminary statements addressing clinical questions related to MIS‐C and hyperinflammation in COVID‐19 were developed based on evidence reports. Consensus was built through a modified Delphi process that involved 2 rounds of anonymous voting and 2 webinars. A 9‐point scale was used to determine the appropriateness of each statement (median scores of 1–3 for inappropriate, 4–6 for uncertain, and 7–9 for appropriate), and consensus was rated as low, moderate, or high based on dispersion of the votes along the numeric scale. Approved guidance statements were those that were classified as appropriate with moderate or high levels of consensus, as prespecified prior to voting. Results The ACR task force approved a total of 128 guidance statements addressing the management of MIS‐C and hyperinflammation in pediatric COVID‐19. These statements were refined into 40 final clinical guidance statements, accompanied by a flow diagram depicting the diagnostic pathway for MIS‐C. Conclusion Our understanding of SARS–CoV‐2–related syndromes in the pediatric population continues to evolve. The guidance provided in this “living document” reflects currently available evidence, coupled with expert opinion, and will be revised as further evidence becomes available.

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Section: Resultsmentioning

confidence: 99%

American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS–CoV‐2 and Hyperinflammation in Pediatric COVID‐19: Version 1

Henderson

Canna

Friedman

et al. 2020

Arthritis & Rheumatology

426

613

View full text Add to dashboard Cite

show abstract

“…Children presenting with fever without a source plus a known or suspected SARS‐CoV‐2 exposures are recommended to undergo screening for MIS‐C, which could include SARS‐CoV‐2 PCR and antibodies, CBC with differential, CRP and ESR. Additional lab work could include ferritin, d ‐dimer, troponin, NT‐proBNP, procalcitonin, and lactate dehydrogenase, plus an electrocardiogram to evaluate for cardiac involvement 69 . Optimal treatment of MIS‐C is uncertain, yet the majority of patients have received immunomodulatory therapy with intravenous immunoglobulin and steroids to dampen the multisystem inflammation.…”

Section: Innate Immune Systemmentioning

confidence: 99%

Insight into the pediatric and adult dichotomy of COVID‐19: Age‐related differences in the immune response to SARS‐CoV‐2 infection

Fialkowski

Gernez

Arya

et al. 2020

Pediatric Pulmonology

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The difference in morbidity and mortality between adult and pediatric coronavirus disease 2019 infections is dramatic. Understanding pediatric‐specific acute and delayed immune responses to severe acute respiratory syndrome coronavirus 2 (SARS‐CoV‐2) is critical for the development of vaccination strategies, immune‐targeted therapies, and treatment and prevention of multisystem inflammatory syndrome in children. The goal of this review is to highlight research developments in the understanding of the immune responses to SARS‐CoV‐2 infections, with a specific focus on age‐related immune responses.

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“…Another guideline recommends that broad-spectrum antibiotics should be prescribed in hospitalized patients because of the overlap of MIS-C symptoms with severe bacterial infections (51). Ceftriaxone should be prescribed in patients with milder illness, and metronidazole should be added in patients with predominant GI symptoms.…”

Section: Treatmentmentioning

confidence: 99%

“…Ceftriaxone should be prescribed in patients with milder illness, and metronidazole should be added in patients with predominant GI symptoms. In cases of severe illness or shock, vancomycin, clindamycin, and cefepime or vancomycin, meropenem, and gentamicin are recommended (51). In children who are PCR-positive and/or have typical COVID-19 manifestations, remdesivir at a dose of 5 mg/kg IV once on day 1 with a maximum dose of 200 mg, followed by 2.5 mg/kg (maximum dose 100 mg) IV daily for nine days, is recommended (51).…”

Section: Treatmentmentioning

confidence: 99%

“…In cases of severe illness or shock, vancomycin, clindamycin, and cefepime or vancomycin, meropenem, and gentamicin are recommended (51). In children who are PCR-positive and/or have typical COVID-19 manifestations, remdesivir at a dose of 5 mg/kg IV once on day 1 with a maximum dose of 200 mg, followed by 2.5 mg/kg (maximum dose 100 mg) IV daily for nine days, is recommended (51). In MIS-C, patients who have an excessive inflammatory response or cardiac involvement, IVIG, and aspirin at doses of 2 g/kg and 80 -100 mg/kg/day, respectively, are recommended (51).…”

Section: Treatmentmentioning

confidence: 99%

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A Review of Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19

Ghodsi¹,

Malek²,

Ghahremani³

2020

Hormozgan medical journal

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: The coronavirus disease 2019 (COVID-19) pandemic, with a high morbidity and mortality rate, has affected all age groups. COVID-19 infection in children usually has minimal symptoms, but the number of children with the inflammatory syndrome with clinical features similar to the Kawasaki disease has increased during the COVID-19 pandemic. Information about this emerging COVID-19 manifestation also called the multisystem inflammatory syndrome in children (MIS-C), is still incomplete. Patients typically present with persistent fever, followed by shock or multi-organ involvement. Laboratory findings and clinical presentation of this multi-organ involvement is part of the diagnostic criteria. Early treatment and multidisciplinary referral to pediatric specialists are essential. The prognosis of MIS-C is not yet fully understood. Although most children survive, several deaths have also been reported. Based on relevant evidence, this study aimed to review the pathophysiology, clinical manifestations, laboratory and imaging findings, diagnosis, treatment recommendations, and prognosis of MIS-C associated with COVID-19.

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COVID-19 associated Multisystem Inflammatory Syndrome in Children (MIS-C) guidelines; a Western New York approach

Cited by 178 publications

References 17 publications

American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS–CoV‐2 and Hyperinflammation in Pediatric COVID‐19: Version 1

American College of Rheumatology Clinical Guidance for Multisystem Inflammatory Syndrome in Children Associated With SARS–CoV‐2 and Hyperinflammation in Pediatric COVID‐19: Version 1

Insight into the pediatric and adult dichotomy of COVID‐19: Age‐related differences in the immune response to SARS‐CoV‐2 infection

A Review of Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19

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