COVID-19 associated Multisystem Inflammatory Syndrome in Children (MIS-C) guidelines; revisiting the Western New York approach as the pandemic evolves

Teresa R Hennon; Karl O A Yu; Michelle D Penque; Rabheh Abdul-Aziz; Arthur C Chang; Megan B McGreevy; John V Pastore; Andrew J Prout; Beverly A Schaefer; Omar S Alibrahim; Oscar G Gomez-Duarte; Mark D Hicar

doi:10.1016/j.ppedcard.2021.101407

COVID-19 associated Multisystem Inflammatory Syndrome in Children (MIS-C) guidelines; revisiting the Western New York approach as the pandemic evolves

Prog Pediatr Cardiol. 2021 Sep:62:101407. doi: 10.1016/j.ppedcard.2021.101407. Epub 2021 Jun 6.

Authors

Teresa R Hennon^{1

2}, Karl O A Yu^{1

2}, Michelle D Penque^{1

2}, Rabheh Abdul-Aziz^{1

2}, Arthur C Chang^{1

2}, Megan B McGreevy^{1

2}, John V Pastore^{1

2}, Andrew J Prout^{3

4}, Beverly A Schaefer^{1

2}, Omar S Alibrahim^{1

2}, Oscar G Gomez-Duarte^{1

2}, Mark D Hicar^{1

2}

Affiliations

¹ Department of Pediatrics, Jacobs School of Medicine and Biomedical Sciences, University at Buffalo, State University of New York, Buffalo, NY, United States of America.
² John R. Oishei Children's Hospital, Buffalo, NY, United States of America.
³ Wayne State University School of Medicine, Detroit, MI, United States of America.
⁴ Children's Hospital of Michigan, Detroit, MI, United States of America.

Abstract

Multisystem inflammatory syndrome of children (MIS-C) continues to be a highly concerning diagnosis in those recently infected with SARS-CoV-2. The diagnosis of MIS-C cases will likely become even more challenging as vaccine uptake and natural immunity in previously infected persons leads to lower circulating rates of SARS-CoV-2 infection and will make cases sporadic. Febrile children presenting with cardiac dysfunction, symptoms overlapping Kawasaki disease or significant gastrointestinal complaints warrant a thorough screen in emergency departments, urgent care centers, and outpatient pediatric or family medicine practices. An increased index of suspicion and discussion regarding higher level of care (transferring to pediatric tertiary care centers or to intensive care) continues to be recommended. Herein we outline a broad approach with a multidisciplinary team for those meeting the case definition and believe such an approach is crucial for successful outcomes.

Keywords: AP, approved; ASO, anti-streptolysin O; BNP, brain-natriuretic peptide; CDC, Center for Disease Control; COVID-19; COVID-19, coronavirus disease 2019; CRP, C-reactive protein; CXCL10, C-X-C-motif chemokine ligand 10; DCBLD2, Discoidin, CUB and LCCL domain-containing protein 2; E, envelope protein; E.U., European Union; ECMO, extracorporeal membrane oxygenation; EKG, electrocardiogram; EM, emergency use; FDA, US Food and Drug Authority; Fever; GI, gastrointestinal; IL, interleukin; IVIG, intravenous immunoglobulin G; Inflammation; KD, Kawasaki disease; LDH, lactate dehydrogenase; LFTs, liver function tests; M, membrane protein; MIS-C; MIS-C, Multisystem Inflammatory Syndrome in Children; Mpred, methylprednisolone; NP, Nucleoprotein; PCR, polymerase chain reaction; PT, prothrombin time; PTT, partial thromboplastin time; Pediatric; RBD, receptor binding domain; SARS-CoV-2; TE, thromboembolic events; TNF, tumor necrosis factor; TWEAK, TNF-like weak inducer of apoptosis; U.S., United States of America; VA, veno-arterial; VLPs, virus-like particles; VTE, venous thromboembolic events.

Publication types

Editorial