Perspective of the Surviving Sepsis Campaign on the Management of Pediatric Sepsis in the Era of Coronavirus Disease 2019*

Abstract

Severe acute respiratory syndrome coronavirus 2 is a novel cause of organ dysfunction in children, presenting as either coronavirus disease 2019 with sepsis and/or respiratory failure or a hyperinflammatory shock syndrome. Clinicians must now consider these diagnoses when evaluating children for septic shock and sepsis-associated organ dysfunction. The Surviving Sepsis Campaign International Guidelines for the Management of Septic Shock and Sepsis-associated Organ Dysfunction in Children provide an appropriate framework for the early recognition and initial resuscitation of children with sepsis or septic shock caused by all pathogens, including severe acute respiratory syndrome coronavirus 2. However, the potential benefits of select adjunctive therapies may differ from non-coronavirus disease 2019 sepsis.

Coronavirus Disease 2019–Associated PICU Admissions: A Report From the Society of Critical Care Medicine Discovery Network Viral Infection and Respiratory Illness Universal Study Registry*

“…IV immunoglobulin (IVIG) is recommended as first-line therapy for MIS-C ( 30 ) but was used in only 45% of MIS-C patients in our cohort compared with 85% in another report ( 8 ). This finding is possibly due to heightened MIS-C recognition over time and anchoring bias ( 31 ), where patients with mild MIS-C may not require therapy such as IVIG. Some centers may also have prioritized data entry on certain days, and we may have missed capturing medication administration.…”

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

“…It is paramount to avoid anchoring bias given that PIMS-TS remains a rare condition ( 34 ), and in view of the fact that many children suffering from other disease during the pandemic may have concomitant microbiological evidence of SARS-CoV-2 exposure. Other, more common differential diagnoses need to be considered, such as but not restricted to:…”

“…Children with PIMS-TS initially often present with signs and symptoms that mimic those of septic shock and toxic shock syndrome ( 34 ) and neither clinical findings (fever, rash, abdominal symptoms), infection markers (CRP), nor other laboratory measures of inflammation may allow reliable discrimination ( 58 , 59 ). Mortality in children with sepsis and septic shock increases as time to effective antimicrobial therapy increases ( 60 , 61 ).…”

Management of Multisystem Inflammatory Syndrome in Children with Combined Use of Corticosteroids and Intravenous Immunoglobulin—Report from Bursa, Turkey

“…The FD-like disease was defined as the presence of fever for ≥3 days and ≥4 of 5 diagnostic criteria (rash, conjunctival injection, cervical lymphadenopathy, changes in the oral mucosa, and changes in the extremities) or three criteria plus coronary artery abnormalities documented by echocardiography. The toxic shock-like disease was defined as cardiovascular dysfunction, which included a decrease in systolic blood pressure of at least 20% or the appearance of signs of peripheral hypoperfusion, 16 17 and the sepsis-like disease was defined as life-threatening organ dysfunction caused by a dysregulated host response to infection. 18 SARS-CoV-2 immunoglobulin M and SARS-CoV-2 immunoglobulin G were detected with automated tests of Abbott MEIA assays.…”