Caring for Critically Ill Children With Suspected or Proven Coronavirus Disease 2019 Infection: Recommendations by the Scientific Sections’ Collaborative of the European Society of Pediatric and Neonatal Intensive Care*

Abstract

Objectives: In children, coronavirus disease 2019 is usually mild but can develop severe hypoxemic failure or a severe multisystem inflammatory syndrome, the latter considered to be a postinfectious syndrome, with cardiac involvement alone or together with a toxic shock like-presentation. Given the novelty of severe acute respiratory syndrome coronavirus 2, the causative agent of the recent coronavirus disease 2019 pandemic, little is known about the pathophysiology and phenotypic expressions of this new infectious disease nor the optimal treatment approach. Study Selection: From inception to July 10, 2020, repeated PubMed and open Web searches have been done by the scientific section collaborative group members of the European Society of Pediatric and Neonatal Intensive Care. Data Extraction: There is little in the way of clinical research in children affected by coronavirus disease 2019, apart from descriptive data and epidemiology. Data Synthesis: Even though basic treatment and organ support considerations seem not to differ much from other critical illness, such as pediatric septic shock and multiple organ failure, seen in PICUs, some specific issues must be considered when caring for children with severe coronavirus disease 2019 disease. Conclusions: In this clinical guidance article, we review the current clinical knowledge of coronavirus disease 2019 disease in critically ill children and discuss some specific treatment concepts based mainly on expert opinion based on limited experience and the lack of any completed controlled trials in children at this time.

An autopsy study of the spectrum of severe COVID-19 in children: From SARS to different phenotypes of MIS-C

“…In this series of five patients, we observed two major patterns of severe COVID-19: a primary pulmonary manifestation, with SARS-CoV-2 pneumonia, observed in patients 1 and 2, or a multisystem inflammatory syndrome with the involvement of several organs and tissues, observed in patients 3 to 5. Other groups have also proposed similar patterns of severe paediatric COVID-19 -a predominant airway/lung disease, and MIS-C [20]. Patients 1 and 2 had severe diseases before SARS-CoV-2 infection, a 15-year-old patient with a terminal neoplastic disease, and a 7-month-old child with Edwards syndrome and a long hospital stay; both presented a pulmonary form of COVID-19.…”

Best Practice Recommendations for the Diagnosis and Management of Children With Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2 (PIMS-TS; Multisystem Inflammatory Syndrome in Children, MIS-C) in Switzerland

“…Subsequent to the first wave of the coronavirus disease 2019 (COVID- 19) pandemic (1), clusters of children presenting with unusual multisystem inflammatory conditions emerged (2,3). The clinical syndrome showed some heterogeneity with patients presenting either akin to toxic shock, Kawasaki-disease like or with undifferentiated inflammatory characteristics, in addition to evidence of current or past COVID-19 infection in the majority of cases (4,5).…”

Potential severe pediatric SARS-CoV-2-induced multisystem inflammatory syndrome resembles dengue infection

“…Recent available guidelines only recommend empirical therapy for MIS-C. Large clinical trials in the pediatric population are lacking. Intravenous immunoglobulin (IVIG), steroids, interleukin (IL-1) receptor antagonist (ra), IL-6 ra, tumor necrosis factor (TNF)-α ra, and anticoagulants are the suggested medication for treating severe MIS-C (Jonat et al, 2020;Rimensberger et al, 2021). Unfortunately, our case occurred in the middle of May 2020, when the MIS-C phenomenon was newly recognized and no therapeutic guideline published.…”