Kawasaki-like COVID-19 disease in children: the keys to cardiac recovery

  • Belhadjer Z & al.
  • Circulation
  • 17 May 2020

  • curated by Emily Willingham, PhD
  • Clinical Essentials
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Takeaway

  • Acute cardiac decompensation in pediatric COVID-19 is rare and could require fewer intensive interventions if caught sufficiently early.
  • Authors: immunoglobulin and steroid treatment is associated with rapid left ventricular (LV) systolic function recovery.
  • The condition is now being called multisystem inflammatory syndrome in children, or MIS-C.

Why this matters

  • Authors: acute heart failure/cardiogenic shock seen with MIS-C is likely the result of myocardial stunning or edema as opposed to inflammatory damage to the myocardium.
  • An algorithm implemented to support early capture seems to be working and reducing the proportion of severe cases.

Key results

  • Median age at admission: 10 (range, 2-16) years.
  • Time from first symptoms of MIS-C to heart failure: median, 6 days.
  • Presentation: fever, weakness.
    • Some had swollen lymph nodes, rash, other Kawasaki-like signs.
    • Gastrointestinal manifestations (vomiting, diarrhea, pain) in 80%.
  • Almost a third had LV ejection fraction
  • 80% needed inotropic support for cardiogenic shock.
  • 29% received extracorporeal membrane oxygenation (all successfully weaned).
  • Inflammatory markers elevated, indicated cytokine storm.
  • 89% SARS-CoV-2-positive.
  • All received intravenous immunoglobulin; a third also received steroids.
  • 25 of 35 had restored LV function at ICU discharge.
  • No coronary aneurysms to date.
  • No deaths, and all but 1 are discharged.

Study design

  • Retrospective case series, 14 pediatric ICUs in France and Switzerland, March 22-April 30, 2020.
  • Funding: None.

Limitations

  • Small, observational.