By April 2020 physicians in the UK/France and the US recognized a unique hyperinflammatory syndrome characterized by fever, cardiovascular shock, and suspected SARS-CoV-2 infection and public health authorities published advisories concerning this entity. In the US, this has been called multisystem inflammatory syndrome in children (MIS-C). Two publications in this volume of The Journal of Pediatrics report data collected between April and July and results published following peer review online in early October 2020 that reflect the beginning of what would be a rapid transition from clinical experience to clinical evidence.
Dove et al performed a survey of US children's medical centers to glean 48 institution's protocols related to diagnosis and management of MIS-C. Reflecting the pandemic spread itself, institutional case counts among participating centers ranged from >25 to none, with over-representation of eastern US institutions. Definitions of MIS-C across protocols generally were similar for presence, but variable for degrees of abnormalities, for fever, organ systems involved, and laboratory markers of inflammation. Management protocols include almost universal guidance for multispecialty consultations and the use of IVIG and corticosteroids, for tiered use of additional drugs (the specifics of which varied across protocols), and for universal cardiology subspecialty follow up. Pending prospective data and controlled drug trials, shared protocols provide a starting point for providers considering management options. It is also noteworthy that although protocols could not have been in place for more than a few weeks, almost one-half had already been revised.
The report of Carlin et al from a large urban children's medical center in New York City was the result of a retrospective case–control study that attempted to find discriminating features between 44 children hospitalized for MIS-C who had treatment intervention and 181 children evaluated in acute-care outpatient visits who had common febrile illnesses. Major findings were the substantially greater odds in children with MIS-C of high fever (median 40°C), of long duration (median 5 days), and complaint of abdominal pain (OR 12.5, 95% CI 1.65–33.24) as well as several findings of the physical examination and abnormalities in laboratory test results (eg, decreased lymphocyte and platelet count and elevated C-reactive protein level). These discriminating features of children with MIS-C are useful for providers to have confidence in their re-assurances that most children evaluated have self-limited illnesses and to recognize manifestations that raise suspicion for progressive MIS-C in a few children.
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