Multisystem Inflammatory Syndrome in pediatric COVID-19 patients: A
Purpose Significant numbers of children and teenagers with COVID-19 have
developed a severe inflammatory condition with a Kawasaki-like disease.
Some needed intensive care unit admission, and others recovered quickly.
We aimed to summarize the clinical and laboratory features of patients
with Kawasaki-like features diagnosed during the COVID-19 pandemic.
Methods A literature search in Web of Science, PubMed, Scopus, and
Science Direct up to June 30, 2020. The mean or untransformed proportion
and 95%CI were estimated. Results Analysis of 15 articles (318 COVID-19
patients) revealed that the mean age was 9.10 years. Although many
presented with typical Kawasaki-like features; fever (82.4%),
polymorphous maculopapular exanthema (63.7%), oral mucosal changes
(58.1%), conjunctival injections (56.0%), edematous extremities
(40.7%), and cervical lymphadenopathy (28.5%), atypical
gastrointestinal (79.4%) and neurocognitive symptoms (31.8%) were also
common. They had elevated LDH, D-dimer, CRP, procalcitonin,
interleukin-6, troponin I levels, and lymphopenia. Nearly 77.0%
developed hypotension, and 68.1% went into shock, while 41.1% had
acute kidney injury. Intensive care was needed in 73.7% of cases,
13.2% were intubated, and 37.9% required mechanical ventilation, with
only one reported fatality case. Intravenous immunoglobulins and
steroids were given in 87.7% and 56.9% of the patients, and
anticoagulants were utilized in 67.0%. Pediatric patients were
discharged after a hospital stay of, on average, 6.77 days
(95%CI:4.93-8.6). Conclusion Recognizing the typical and atypical
presentation of pediatric COVID-19 patients has important implications
in identifying children at risk. Monitoring cardiac and renal
decompensation and early interventions in patients with “multisystem
inflammatory syndrome” is critical to prevent further morbidity.