Background:
Coronavirus disease 2019(COVID-19) is responsible for significant lung disease in adults. Despite mild manifestations in most children, multisystem inflammatory syndrome (MIS-C) associated with COVID-19 is well-described in older children with cardiac manifestations. However, MIS-C-related cardiac manifestations are not as well-described in younger children.
Methods:
The study is a retrospective analysis of MIS-C patients under age 5 years admitted between May to November 2020 to a single-center. Included cases fulfilled the case definition of MIS-C according to RCPCH criteria with cardiac laboratory, ECG, or echocardiographic evidence of cardiac disease. Collected Data included patients’ demographics, laboratory results, echocardiographic findings, management, and outcomes.
Results:
Out of 16 MIS-C cases under 5 years, 10 (62.5%) had cardiac manifestations with a median age of 12 months, 9 (90%) were previously healthy. Cardiac manifestations included coronary arterial aneurysms or ectasia in 5 (50%) cases, 2 (20%) with isolated myopericarditis, coronary aneurysm with myocarditis in 2 (20%), and SVT in 1(10%). Intravenous immunoglobulins were given in all cases with coronary aneurysms or myocarditis. The median duration of hospitalization was 7(6-14) days; 2 (20%) cases with cardiac disease were mechanically ventilated and mortality in MIS-C cases below 5years was 12.5%. Normalization of systolic function occurred in half of the affected cases within one week and reached 100% by 30days of follow-up.
Conclusion:
MIS-C associated with SARS-CoV-2 has a high possibility of serious associated cardiac manifestations in children under the age of 5years with mortality and/or long-term morbidities such as coronary aneurysms even in previously healthy pediatric patients.
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