Severe manifestations of SARS-CoV-2 in children and adolescents: from COVID-19 pneumonia to multisystem inflammatory syndrome: a multicentre study in pediatric intensive care units in Spain

• Published in: Critical Care 2020, Vol.24 (1)
• Main Authors: García-Salido, Alberto, de Carlos Vicente, Juan Carlos, Belda Hofheinz, Sylvia, Balcells Ramírez, Joan, Slöcker Barrio, María, Leóz Gordillo, Inés, Hernández Yuste, Alexandra, Guitart Pardellans, Carmina, Cuervas-Mons Tejedor, Maite, Huidobro Labarga, Beatriz, Vázquez Martínez, José Luís, Gutiérrez Jimeno, Míriam, Oulego-Erróz, Ignacio, Trastoy Quintela, Javier, Medina Monzón, Carmen, Medina Ramos, Laura, Holanda Peéa, María Soledad, Gil-Antón, Javier, Sorribes Ortí, Clara, Flores González, José Carlos, Hernández Palomo, Rosa María, Sánchez Ganfornina, Inma, Fernández Romero, Emilia, García-Besteiro, María, López-Herce Cid, Jesús, González Cortés, Rafael, Bustinza Arriortua, Amaya, Oyágüez Ugidos, Pedro Pablo, Jordan, Iolanda, Sanchíz Cárdenas, Sonia, Joyanes, Belén, Jiménez Olmos, Ainhoa, Rodríguez Núéez, Antonio, Díaz Munilla, Laura, Solís Reyes, Carlos, Roca Pascual, David, Ballcels Ramírez, Joan, Sánchez Fernández, Mario, Nieto Moro, Montserrat, Martínez de Azagra Garde, Amelia, García Teresa, María Ãngeles, Rey Galán, Corsino, Molina Cambra, Alfredo, González-Ripoll Garzón, Manuel, Fernández-Cantalejo Padial, Pepe, Oulego-Erroz, Ignacio, Vega Puyal, Laia, Moreno, Daniel, García Besteiro, María, Calvo Monge, Cristina, Fernández, Francisco, González, Nieves, Bermúdez Barrezueta, Lorena, Villa Francisco, Cesar, Abril Molina, Ana, Valeron, Mónica, Hernández Rastrollo, Ramón, Gijón Mediavilla, Manuel, Vázquez Martínez, José Luis, Frias, Manuel, Montero Yéboles, Raúl, Muéóz Bonet, Juan Ignacio, Velázquez, María, Pérez Iranzo, Antonio, Lozano, David, Gutiérrez Jimeno, Miriam
• Format: Report
• Language: English
• Subjects: Bacterial pneumonia; Care and treatment; Demographic aspects; Pediatric research; Pneumonia; Statistics
• ISSN: 1364-8535
• DOI: 10.1186/s13054-020-03332-4

Background Multisystem inflammatory syndrome temporally associated with COVID-19 (MIS-C) has been described as a novel and often severe presentation of SARS-CoV-2 infection in children. We aimed to describe the characteristics of children admitted to Pediatric Intensive Care Units (PICUs) presenting with MIS-C in comparison with those admitted with SARS-CoV-2 infection with other features such as COVID-19 pneumonia. Methods A multicentric prospective national registry including 47 PICUs was carried out. Data from children admitted with confirmed SARS-CoV-2 infection or fulfilling MIS-C criteria (with or without SARS-CoV-2 PCR confirmation) were collected. Clinical, laboratory and therapeutic features between MIS-C and non-MIS-C patients were compared. Results Seventy-four children were recruited. Sixty-one percent met MIS-C definition. MIS-C patients were older than non-MIS-C patients (p = 0.002): 9.4 years (IQR 5.5-11.8) vs 3.4 years (IQR 0.4-9.4). A higher proportion of them had no previous medical history of interest (88.2% vs 51.7%, p = 0.005). Non-MIS-C patients presented more frequently with respiratory distress (60.7% vs 13.3%, p < 0.001). MIS-C patients showed higher prevalence of fever (95.6% vs 64.3%, p < 0.001), diarrhea (66.7% vs 11.5%, p < 0.001), vomits (71.1% vs 23.1%, p = 0.001), fatigue (65.9% vs 36%, p = 0.016), shock (84.4% vs 13.8%, p < 0.001) and cardiac dysfunction (53.3% vs 10.3%, p = 0.001). MIS-C group had a lower lymphocyte count (p < 0.001) and LDH (p = 0.001) but higher neutrophil count (p = 0.045), neutrophil/lymphocyte ratio (p < 0.001), C-reactive protein (p < 0.001) and procalcitonin (p < 0.001). Patients in the MIS-C group were less likely to receive invasive ventilation (13.3% vs 41.4%, p = 0.005) but were more often treated with vasoactive drugs (66.7% vs 24.1%, p < 0.001), corticosteroids (80% vs 44.8%, p = 0.003) and immunoglobulins (51.1% vs 6.9%, p < 0.001). Most patients were discharged from PICU by the end of data collection with a median length of stay of 5 days (IQR 2.5-8 days) in the MIS-C group. Three patients died, none of them belonged to the MIS-C group. Conclusions MIS-C seems to be the most frequent presentation among critically ill children with SARS-CoV-2 infection. MIS-C patients are older and usually healthy. They show a higher prevalence of gastrointestinal symptoms and shock and are more likely to receive vasoactive drugs and immunomodulators and less likely to need mechanical ventilation than non-MIS