Multisystem Inflammatory Syndrome in Children in New York State

Dufort, Elizabeth; Koumans, Emilia H.; Chow, Eric J; Rosenthal, Elizabeth M.; Muse, Alison; Rowlands, Jemma; Barranco, Meredith A.; Maxted, Angela M.; Rosenberg, Eli S.; Easton, Delia; Udo, Tomoko; Kumar, Jessica; Pulver, W; Smith, Lesley Ann; Hutton, Brad; Blog, Debra; Zucker, Howard A.

doi:10.1056/nejmoa2021756

Cited by 1,174 publications

(1,931 citation statements)

References 18 publications

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“…As in different studies, our MIS-C case followed the peak of infection by almost two weeks, which support that this syndrome is probably a post infectious in ammatory process related to Covid-19 12,13 . A profound in ammatory response resulting in Acute Respiratory Distress Syndrome (ARDS) and multiorgan failure seems to be an essential component of the critical illness associated with COVID-19.…”

Section: Discussionsupporting

confidence: 89%

“…Two molecular tests for SARS-CoV-2 were negative. The discharge diagnoses were cellulitis, and shock 12 .…”

Section: Discussionmentioning

confidence: 99%

“…Dose of Anakinra was (2mg/kg) loading dose(table1), followed by a continuous infusion of (0.02ml/kg/hour) 12 . E cacy and safety-wise were the reasons to give continuous infusion, not subcutaneous (SC) injection, as there is no recommended dose for this age group as SC injection.…”

Section: Case Presentationmentioning

confidence: 99%

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Refractory Multi-inflammatory Syndrome in a two weeks old neonate with COVID-19 Treated Successfully with Intravenous Immunoglobulin, Steroids and Anakinra

Magboul

Khalil

Al-Shami

et al. 2020

Preprint

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Background: World Health Organization (WHO) and other Health officials alert clinicians about a rare but severe inflammatory condition seen in children and linked to Corona Virus Disease 2019(COVID-19). The WHO is describing the condition as a multisystem inflammatory syndrome in children (MIS-C) and is recommending clinicians to report those cases to get a better understanding of the disease and clinicians can learn more.Case presentation: We are reporting the clinical course of the youngest case of COVID-19 related MIS-c; a two-week-old term neonate with COVID-19 infection and features suggestive of MIS-C , managed with intravenous immunoglobulin (IVIG), pulse steroid, and interleukin-1 inhibitor (Anakinra).By reviewing the literature, our baby is the first neonatal case who has been diagnosed with MIS-C.Conclusion: COVID-19 infection in pediatrics are likely to present with a mild course; however, some may develop a hyper-inflammatory syndrome. Pediatricians should be aware of such presentation, the clinical course, the management modalities, and inform parents and caregivers about common signs and symptoms. Anakinra may consider as effective second agent in (IVIG and steroid-refractory pediatric cases).

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Section: Discussionsupporting

confidence: 89%

“…Two molecular tests for SARS-CoV-2 were negative. The discharge diagnoses were cellulitis, and shock 12 .…”

Section: Discussionmentioning

confidence: 99%

See 1 more Smart Citation

Refractory Multi-inflammatory Syndrome in a two weeks old neonate with COVID-19 Treated Successfully with Intravenous Immunoglobulin, Steroids and Anakinra

Magboul

Khalil

Al-Shami

et al. 2020

Preprint

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“…The original studies 5,39,[56][57][58][59][60][61][62][63][64] on the laboratory findings on children with MIS during the COVID-19 pandemic are shown in Table 2.…”

Section: Mis In Children With Covid-19mentioning

confidence: 99%

Hematological manifestations of SARS‐CoV‐2 in children

Kosmeri

Koumpis

Tsabouri

et al. 2020

Pediatric Blood & Cancer

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Infection from severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2), though mainly a respiratory disease, can impair many systems, including causing hematological complications. Lymphopenia and hypercoagulability have been reported in adults with coronavirus disease 2019 (COVID-19) and are considered markers of poor prognosis. This review summarizes the hematological findings in children with SARS-CoV-2 infection. The majority of infected children had a normal leukocyte count, while the most common white blood cell abnormality was leukopenia. Lymphopenia, which may be a marker of severe disease, was rarer in children than in adults, possibly due to their immature immune system or due to the less severe manifestation of COVID-19 in this age group. Age may have an impact, and in neonates and infants the most common abnormality was lymphocytosis. Abnormalities of red blood cells and platelets were uncommon. Anemia and hypercoagulability were reported mainly in children presenting the novel multisystem inflammatory syndrome (MIS) associated with SARS-CoV-2.

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“…MISC, Multisystem Inflammatory Syndrome in Children; PICU, Pediatric Intensive Care Unit; PIMS-TS, Pediatric Inflammatory Multisystem Syndrome-temporally associated with SARS-CoV-2 . a Feldstein et al ( 19 ) excluded cases in the cohort described by Dufort et al ( 20 ) (n = 27), but included cases reported by Chiotos et al ( 7 ) (n = 6) and Waltuch et al ( 21 ) (n = 4). Feldstein et al ( 19 ): 186 cases meeting the case definition included out of 234 reported cases .…”

Section: Statementmentioning

confidence: 99%

Pediatric Inflammatory Multisystem Syndrome: Statement by the Pediatric Section of the European Society for Emergency Medicine and European Academy of Pediatrics

et al. 2020

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A rise in cases with a new hyperinflammatory disease in children has been reported in Europe and in the Unites States of America, named the Pediatric Inflammatory Multisystem Syndrome—temporally associated with SARS-CoV-2 (PIMS-TS). There appears to be a wide spectrum of signs and symptoms with varying degrees of severity, including a toxic shock like presentation with hypovolaemia and shock, and a Kawasaki-like presentation with involvement of the coronary arteries. Most of these children have evidence of a previous infection with SARS-CoV-2, or a history of significant exposure, but not all. Limited data exist on the incidence of PIMS-TS, but it remains a rare condition. Early recognition and escalation of care is important to prevent the development of serious sequelae, such as coronary artery aneurysms. Clinicians assessing febrile children in primary and secondary care should include PIMS-TS in their differential diagnoses. In children fulfilling the case definition, additional investigations should be undertaken to look for evidence of inflammation and multiorgan involvement. Suspected cases should be discussed with experts in pediatric infectious diseases at an early stage, and advice should be sought from critical care in more severe cases early. There is limited consensus on treatment; but most children have been treated with immunoglobulins or steroids, and with early consideration of biologicals such anti-TNF and anti-IL1 agents. Treatment should ideally be within the context of controlled treatment trials. Clinicians are encouraged to document and share their cases using research registries.

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Multisystem Inflammatory Syndrome in Children in New York State

Cited by 1,174 publications

References 18 publications

Refractory Multi-inflammatory Syndrome in a two weeks old neonate with COVID-19 Treated Successfully with Intravenous Immunoglobulin, Steroids and Anakinra

Refractory Multi-inflammatory Syndrome in a two weeks old neonate with COVID-19 Treated Successfully with Intravenous Immunoglobulin, Steroids and Anakinra

Hematological manifestations of SARS‐CoV‐2 in children

Pediatric Inflammatory Multisystem Syndrome: Statement by the Pediatric Section of the European Society for Emergency Medicine and European Academy of Pediatrics

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