Protecting children

Although multisystem inflammatory syndrome in children (MIS-C) does not have a high fatality rate, doctors say that early detection is a must.

DIAGNOSTIC CRITERIA All of these:

Fever ≥ 3 days; elevated markers of inflammation such as ESR, C-reactive protein, or procalcitonin; no other obvious microbial cause of inflammation; Covid+, or likely contact with Covid patients.

AND two of these:

• Rash or bilateral non-purulent l conjunctivitis or muco-cutaneous l inflammation signs (oral, l hands or feet).

• Hypotension or shock.

• Features of myocardial dysfunction, pericarditis, valvulitis, or coronary abnormalities

• Evidence of coagulopathy

• Acute gastrointestinal problems

TREATMENT Stage 1

The child needs appropriate supportive care, preferably in ICU. In absence of cardiac dysfunction, shock, coronary involvement, multi organs dysfunction, one may use steroids or IVIG (Intravenous Immunoglobulin).

• Steroids: Methylprednisolone 1 to 2 mg/kg per day.

• IVIG 2 g/kg over 24 to 48 hours.

• Antimicrobials

Stage 2

• Repeat IVIG

• High dose corticosteroid (Methylprednisolone 10 to 30 mg/kg/day for 3 to 5 days)

• Aspirin: 3 mg/kg/day to 5 mg/kg/day max 81 mg/day (if thromobosis or coronary aneurysm score is >2.5)

• Low Molecular Weight Heparin: Enoxaparin: 1 mg/kg twice daily subcutaneously. Clotting Factor Xa should be between 0.5 to 1 (if patient has thrombosis/ Coronary aneurysm score > 10 or LVEF < 30%)

Steroids have to be tapered over 2 to 3 weeks while monitoring inflammatory markers. For children with cardiac involvement, monitoring is a must.