IVIG plus Glucocorticoids versus IVIG Alone in Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19: A Systematic Review and Meta-Analysis

Rauniyar, Robin; Mishra, Aman; Kharel, Sanjeev; Giri, Subarna; Rauniyar, Rohit; Yadav, Shikha; Chaudhary, Gajendra

doi:10.1155/2022/9458653

Cited by 7 publications

(3 citation statements)

References 19 publications

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“…Interestingly, the combination did not significantly reduce the risk of left ventricular dysfunction and need for inotropic support, which are predominant morbidities of MIS-N. This highlights the need to re-evaluate the efficacy of use of individual agents and combination therapy in the neonatal population [ 44 ].…”

Section: Discussionmentioning

confidence: 99%

Multisystem inflammatory syndrome in neonates (MIS-N): a systematic review

et al. 2023

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Recently, a new pattern of multisystem inflammatory syndrome following an infection with severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) has emerged globally. The initial cases were described in the adult population followed by sporadic cases in the pediatric population also. By the end of 2020, similar reports were recognised in the neonatal age group. The purpose of this study was to systematically review clinical characteristics, laboratory parameters, treatment, and outcomes of neonates with multisystem inflammatory syndrome in neonates (MIS-N). A systematic review was conducted after registering with PROSPERO and electronic databases including MEDLINE, EMBASE, PubMed, SCOPUS, Google Scholar, and Web of Science were searched from January 1st 2020 till September 30th 2022. A total of 27 studies describing 104 neonates were analysed. The mean gestation age and birth weight was 35.9 ± 3.3 weeks and 2255.7 ± 783.7 g respectively. A large proportion (91.3%) of the reported cases belonged to the South-East Asian region. The median age of presentation was 2 days (range: 1–28 days) with cardiovascular system being the predominant system involved in 83.65% followed by respiratory (64.42%). Fever was noted in only 20.2%. Commonly elevated inflammatory markers were IL-6 in 86.7% and D-dimer in 81.1%. Echocardiographic evaluation suggested ventricular dysfunction in 35.8% and dilated coronary arteries in 28.3%. Evidence of SARS-CoV-2 antibodies (IgG or IgM) was seen in 95.9% neonates and evidence of maternal SARS-CoV-2 infection, either as history of COVID infection or positive antigen or antibody test, was noted in 100% of the cases. Early MIS-N was reported in 58 (55.8%) cases, late MIS-N in 28 (26.9%), and 18 cases (17.3%) did not report the timing of presentation. There was a statistically increased proportion of preterm infants (67.2%, p < 0.001), and a trend towards increased low birth weight infants, in the early MIS-N group when compared to the infants with late MIS-N. Fever (39.3%), central nervous system (50%), and gastrointestinal manifestations (57.1%) were significantly higher in the late MIS-N group ( p = 0.03, 0.02, 0.01 respectively). The anti-inflammatory agents used for the treatment of MIS-N included steroids 80.8% which were given for a median of 10 (range 3–35) days and IVIg in 79.2% with a median of 2 (range 1–5) doses. The outcomes were available for 98 cases, of whom 8 (8.2%) died during treatment in hospital and 90 (91.8%) were successfully discharged home. Conclusion : MIS-N has a predilection for late preterm males with predominant cardiovascular involvement. The diagnosis is challenging in neonatal period due to overlap with neonatal morbidities and a high risk of suspicion is warranted, especially in presence of supportive maternal and neonatal clinical history. The major limitation of the review was inclusion of case reports and case series, and highlights need of global registries for MIS-N. ...

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Section: Discussionmentioning

confidence: 99%

Multisystem inflammatory syndrome in neonates (MIS-N): a systematic review

et al. 2023

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“…Nonetheless, studies suggested using combination therapy [ 10 , 37 ]. In a one-year follow-up of MIS-C patients, more (57%) were recovered from both IVIG + methylprednisolone (combination) treatment, compared to the ones recovered from only IVIG (1.8%) and only methylprednisolone (18%) [ 38 ].…”

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confidence: 99%

New insight into the intravenous immunoglobulin treatment in Multisystem Inflammatory Syndrome in children and adults

Chen,

Kao,

Huang

et al. 2024

Ital J Pediatr

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Within 6 months of the coronavirus pandemic, a new disease entity associated with a multisystem hyperinflammation syndrome as a result of a previous infection with the SARS-CoV-2 virus is increasingly being identified in children termed Multisystem Inflammatory Syndrome in Children (MIS-C) and more recently in adults(MIS-A). Due to its clinical similarity with Kawasaki Disease, some institutions have used intravenous immunoglobulins and steroids as first line agents in the management of the disease. We seek to find how effective intravenous immunoglobulin therapy is across these two disease entities. A comprehensive English literature search was conducted across PubMed, MEDLINE, and EMBASE databases using the keywords multisystem inflammatory syndrome in children/adults and treatment. All major online libraries concerning the diagnosis and treatment of MIS-C and MIS-A were searched. Relevant papers were read, reviewed, and analyzed. The use of intravenous immunoglobulins (IVIG) and steroids for the treatment of multisystemic inflammatory syndrome in children(MIS-C) is well established and recommended by multiple pediatric governing institutions. However, there is still no optimal treatment guideline or consensus on the use of IVIG in adults. The use of IVIG in both the child and adult populations may lower the risk of treatment failure and the need for adjunctive immunomodulatory therapy. Despite the promising results of IVIG use for the management of MIS-C and MIS-A, considering the pathophysiological differences between MIS-C and MIS-A, healthcare professionals need to further assess the differences in disease risk and treatment. The optimal dose, frequency, and duration of treatment are still unknown, more research is needed to establish treatment guidelines.

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“…These results were statistically significant. 62 In addition to that, Anakinra (IL1 receptor antagonist) and infliximab (TNF -α receptor antagonist) are used in the treatment of refractory MIS-C in order to further reduce the patients' hyperinflammatory state. 57 Patients are considered refractory if they do not show improvement during the first 24 hours of administration of treatment.…”

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confidence: 99%

Multisystem inflammatory syndrome in children: another COVID-19 sequel

Rassi,

Zareef,

Honeini

et al. 2023

Cardiol Young

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With the rapid expansion of the COVID-19 pandemic, the disease burden and its consequences on the paediatric population has been progressively recognised. Although COVID-19 infection in children presents as asymptomatic to mild illness, instances of hyperinflammation and multi-organ involvement following the viral infection have been described. This condition, known as the multisystem inflammatory syndrome in children (MIS-C), has gained a wide global attention. Despite the global efforts to uncover the disease characteristics and management, a clear pathogenesis and a unified treatment regimen have not been reached yet. This paper tackles the epidemiology of the MIS-C, discusses its suggested pathogenesis, drives through its varying clinical presentations, and evaluates the different treatment regimens employed in managing MIS-C.

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IVIG plus Glucocorticoids versus IVIG Alone in Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19: A Systematic Review and Meta-Analysis

Cited by 7 publications

References 19 publications

Multisystem inflammatory syndrome in neonates (MIS-N): a systematic review

Multisystem inflammatory syndrome in neonates (MIS-N): a systematic review

New insight into the intravenous immunoglobulin treatment in Multisystem Inflammatory Syndrome in children and adults

Multisystem inflammatory syndrome in children: another COVID-19 sequel

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