465 Paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 infection: A children’s hospital experience

• Published in: Archives of disease in childhood 2023-07, Vol.108 (Suppl 2), p.A382-A383
• Main Authors: Rao, Haritha, Ukeje, Chibuko, Jamison, Laura, Pavanasam Ramesh, Mikrou, Paraskevi
• Format: Article
• Language: English
• Subjects: Aspirin; Cardiology; Children; Clindamycin; Coronary artery; COVID-19; Delphi Technique; Echocardiography; Effusion; EKG; Epidemiology; Heart; Herd immunity; Hospitals; Immunization; Immunoglobulins; Inflammation; Intensive care units; National Standards; Patients; Pediatrics; Phenotypes; Regurgitation; Sepsis; Septic shock; Severe acute respiratory syndrome coronavirus 2; Toxic shock syndrome; Ultrasonic imaging; Ventricle
• ISSN: 0003-9888; 1468-2044
• DOI: 10.1136/archdischild-2023-rcpch.601

BackgroundPaediatric Inflammatory Multisystem Syndrome temporally associated with SARS-CoV-2 infection (PIMS-TS) was first reported in April 2020. 268 cases were identified in the UK with symptom onset between 1st March and 15th June 2020[1]. Staffordshire Children’s Hospital has one of the two Paediatric Intensive Care Units in the West Midlands region and is a level 3 Local Cardiology Centre with Paediatricians with expertise in Cardiology.ObjectivesTo audit the management and outcomes of children with PIMS-TS admitted to Staffordshire Children’s Hospital with specific focus on cardiovascular findings.MethodData of children who were admitted with PIMS-TS over an 18-month period (June 2020-January 2022) was retrospectively audited against the national consensus standards published in September 2020 (Harwood et al) [2]. Some of these patients were managed prior to the publication of standards. Criteria audited included: investigations performed, acute management, outpatient follow-up and outcomes.ResultsA total of 12 patients were admitted with PIMS-TS. Age range was 2–14 years (median 11 years). Male to female ratio was 1:2. All patients had the recommended blood tests, cardiac investigations (12-lead ECG, echocardiogram) and treatment for suspected sepsis within the suggested timeframes. All 12 cases were discussed with the specialist regional COVID-19 multidisciplinary team (MDT) within 24 hours of admission.Eight patients (67%) presented as the Kawasaki phenotype, and all received intravenous immunoglobulins and high dose aspirin. Ten patients (83%) were treated for toxic shock syndrome (100% received clindamycin). Daily echocardiograms were performed in 2 of the 5 unstable patients, but this did not alter their outcome.11 of 12 patients had abnormal echocardiograms on admission: Atrio-ventricular (AV) valve regurgitation (6 of 12), mild or moderate impairment of Left Ventricular (LV) function (7 of 12), coronary artery prominence/dilatation (3 of 12) and pericardial effusion (2 of 12). There were no deaths, and all patients were discharged home. First and second cardiology follow up reviews were done in 83% & 75% patients within the specified time frame. Only 2 of 12 patients continued to have an abnormal echocardiogram on the first follow-up.ConclusionThere was good adherence to national standards in most of the patients, even for those cases that were managed prior to the publication of the national consensus guidelines. Our local pathway is in-keep