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Cardiac implications of multisystem inflammatory syndrome associated with COVID-19 in children under the age of 5 years

Part of: Echocardiography Covid-19

Published online by Cambridge University Press:  15 July 2021

Shaimaa Rakha Open the ORCID record for Shaimaa Rakha [Opens in a new window] ,
Ali Sobh ,
Amira H. Hager ,
Mona Hafez ,
Gehan A. Alsawah ,
Mohamed Magdi Abuelkheir ,
Mayada Sabry Zeid ,
Mohamed Nahas  and
Hala Elmarsafawy Open the ORCID record for Hala Elmarsafawy [Opens in a new window]
Shaimaa Rakha*
Affiliation:
Pediatric Cardiology Unit, Pediatrics Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Ali Sobh
Affiliation:
Pediatric Infections and Immunology Unit, Pediatrics department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Amira H. Hager
Affiliation:
Pediatric Cardiology Unit, Pediatrics Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Mona Hafez
Affiliation:
Pediatric Cardiology Unit, Pediatrics Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Gehan A. Alsawah
Affiliation:
Pediatric Cardiology Unit, Pediatrics Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Mohamed Magdi Abuelkheir
Affiliation:
Pediatric Cardiology Unit, Pediatrics Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Mayada Sabry Zeid
Affiliation:
Pediatric Infections and Immunology Unit, Pediatrics department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Mohamed Nahas
Affiliation:
Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Hala Elmarsafawy
Affiliation:
Pediatric Cardiology Unit, Pediatrics Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
*
Author for correspondence: Shaimaa Rakha, MD, MRCPCH, Pediatric Cardiology Unit, Mansoura University Children Hospital, El Gomhouria St, Mansoura, Dakahlia Governorate 35516, Egypt. Tel: +201030077567. Email: drshimaarhaka@mans.edu.eg
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Abstract

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 the age of 5 years admitted between May and November 2020 to a single centre. Included cases fulfilled the case definition of MIS-C according to Royal College of Pediatrics and Child Health criteria with laboratory, electrocardiogram, 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 of age, 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 five (50%) cases, two (20%) with isolated myopericarditis, coronary ectasia with myocarditis in two (20%), and supraventricular tachycardia in one (10%). Intravenous immunoglobulins were given in all cases with coronary involvement or myocarditis. The median duration of hospitalisation was 7 (6–14) days; two (20%) cases with cardiac disease were mechanically ventilated and mortality in MIS-C cases below 5 years was 12.5%. Normalisation of systolic function occurred in half of the affected cases within 1 week and reached 100% by 30 days of follow-up.

Conclusions:

MIS-C associated with SARS-CoV-2 has a high possibility of serious associated cardiac manifestations in children under the age of 5 years with mortality and/or long-term morbidities such as coronary aneurysms even in previously healthy children.

Keywords

Cardiacmultisystem inflammatory syndromeCOVID-19under 5 years
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 5 , May 2022 , pp. 800 - 805
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Shaimaa Rakha and Ali Sobh are equal first authors.

References

Cucinotta, D, Vanelli, M. WHO declares COVID-19 a pandemic. Acta Biomed 2020; 91: 157–160.Google Scholar
Mehta, P, McAuley, DF, Brown, M, Sanchez, E, Tattersall, RS, Manson, JJ. COVID-19: consider cytokine storm syndromes and immunosuppression. Lancet 2020; 395: 1033–1034.CrossRefGoogle ScholarPubMed
World Health Organization. Multisystem inflammatory syndrome in children and adolescents with COVID-19. Available at: https://www.who.int/publications/i/item/ multisystem-inflammatory-syndrome-in-childrenand-adolescents-with-covid-19. Accessed August 23, 2020.Google Scholar
CDC Health Alert Network. Multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19). Available at: https://emergency.cdc.gov/han/2020/han00432.asp. Accessed July 30, 2020.Google Scholar
RCPCH. Paediatric multisystem inflammatory syndrome temporally associated with COVID-19 (PIMS) – guidance for clinicians. https://www.rcpch.ac.uk/resources/paediatric-multisystem-inflammatory-syndrome-temporally-associated-covid-19-pims-guidance.Google Scholar
Toubiana, J, Poirault, C, Corsia, A, et al. Kawasaki-like multisystem inflammatory syndrome in children during the covid-19 pandemic in Paris, France: prospective observational study. BMJ 2020; 369: m2094.CrossRefGoogle Scholar
Verdoni, L, Mazza, A, Gervasoni, A, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet 2020; 395: 1771–1778.CrossRefGoogle Scholar
Ouldali, N, Pouletty, M, Mariani, P, et al. Emergence of Kawasaki disease related to SARS-CoV-2 infection in an epicentre of the French COVID-19 epidemic: a time-series analysis. Lancet Child Adolesc Health 2020; 4: 662–668.CrossRefGoogle Scholar
Sperotto, F, Friedman, KG, Son, MBF, VanderPluym, CJ, Newburger, JW, Dionne, A. Cardiac manifestations in SARS-CoV-2-associated multisystem inflammatory syndrome in children: a comprehensive review and proposed clinical approach. Eur J Pediatr 2021; 180: 307–322.CrossRefGoogle Scholar
Ramcharan, T, Nolan, O, Lai, CY, et al. Paediatric inflammatory multisystem syndrome: temporally associated with SARS-CoV-2 (PIMS-TS): cardiac features, management and short-term outcomes at a UK tertiary paediatric hospital. Pediatr Cardiol 2020; 41: 1391–1401.CrossRefGoogle Scholar
Consiglio, CR, Cotugno, N, Sardh, F, et al. The immunology of multisystem inflammatory syndrome in children with COVID-19. Cell 2020; 183: 968–981.e7.CrossRefGoogle ScholarPubMed
Dufort, EM, Koumans, EH, Chow, EJ, et al. Multisystem inflammatory syndrome in children in New York state. N Engl J Med 2020; 383: 347–358.CrossRefGoogle ScholarPubMed
Lopez, L, Colan, SD, Frommelt, PC, et al. Recommendations for quantification methods during the performance of a pediatric echocardiogram: a report from the Pediatric Measurements Writing Group of the American Society of Echocardiography Pediatric and Congenital Heart Disease Council. J Am Soc/Echocardiogr 2010; 23: 465–495.CrossRefGoogle ScholarPubMed
Tissot, C, Singh, Y, Sekarski, N. Echocardiographic evaluation of ventricular function-for the neonatologist and pediatric intensivist. Front Pediatr 2018; 6: 79.CrossRefGoogle ScholarPubMed
McCrindle, BW, Rowley, AH, Newburger, JW, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a scientific statement for health professionals from the American Heart Association. Circulation 2017; 135: 927–999.CrossRefGoogle ScholarPubMed
Jiang, L, Tang, K, Levin, M, et al. COVID-19 and multisystem inflammatory syndrome in children and adolescents. Lancet Infect Dis 2020; 20: e276–e288.CrossRefGoogle Scholar
Belhadjer, Z, Méot, M, Bajolle, F, et al. Acute heart failure in multisystem inflammatory syndrome in children in the context of global SARS-CoV-2 pandemic. Circulation 2020; 142: 429–436.CrossRefGoogle Scholar
Ahmed, M, Advani, S, Moreira, A, et al. Multisystem inflammatory syndrome in children: a systematic review. EClinicalMedicine 2020; 26: 100527.CrossRefGoogle ScholarPubMed
Matsubara, D, Kauffman, HL, Wang, Y, et al. Echocardiographic findings in pediatric multisystem inflammatory syndrome associated with COVID-19 in the United States. J Am Coll Cardiol 2020; 76: 1947–1961.CrossRefGoogle ScholarPubMed
Feldstein, LR, Tenforde, MW, Friedman, KG, et al. Characteristics and outcomes of US children and adolescents with multisystem inflammatory syndrome in children (MIS-C) compared with severe acute COVID-19. JAMA 2021; 325: 1074–1087.CrossRefGoogle ScholarPubMed
Feldstein, LR, Rose, EB, Horwitz, SM, et al. Multisystem inflammatory syndrome in U.S. children and adolescents. N Engl J Med 2020; 383: 334–346.CrossRefGoogle ScholarPubMed
Dionne, A, Kheir, JN, Sleeper, LA, Esch, JJ, Breitbart, RE. Value of Troponin testing for detection of heart disease in previously healthy children. J Am Heart Assoc 2020; 9:e012897.CrossRefGoogle ScholarPubMed