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Treatments Restore Heart Function in Children With COVID-19-Realted Condition

As alarming as COVID-related multi-system inflammatory syndrome in children might be, a new study points out that the condition remains rare and appears to respond well to some treatment. Find out what therapies helped restore heart function in a majority of children with the condition.

PARIS, FRANCE – Steroid treatment and immune globulin therapy restored heart function in most of the children with COVID-related multi-system inflammatory syndrome, according to a new study.

The article in Circulation discussed the condition which has affecteda small number of children exposed to COVID-19. The emerging condition has features that overlap with toxic shock syndrome and Kawasaki disease, as well as cardiac inflammation, according to Université de Paris-led researchers.

Common symptoms are high-spiking fever, asthenia, digestive signs including severe abdominal pain, vomiting or diarrhea, adenopathy and skin rash, according to the report.

The authors note that SARS-CoV-2 infection in children is usually minimally symptomatic. Over a two-month period during the pandemic in France and Switzerland, researchers retrospectively collected clinical, biological, therapeutic, and early outcomes data in children who were admitted to pediatric intensive care units in 14 centers for cardiogenic shock, left ventricular dysfunction and severe inflammatory state.

Ultimately, the study included 35 children with median age at admission of 10. About a fourth, 28%, had comorbidities, including asthma and overweight. Gastrointestinal symptoms were prominent in the patients, affecting more than 80%.

In addition, left ventricular ejection fraction was less than 30% in one third, while 80% required inotropic support with 28% treated with extracorporeal membrane oxygenation.

Researchers note that inflammation markers were suggestive of cytokine storm (interleukin 6 median 135 pg/mL) and macrophage activation (D-dimer median 5284 ng/mL). Mean brain natriuretic peptide was also elevated (5743 pg/mL).

Most, 88%, of the patients tested positive for SARS-CoV-2 infection by PCR of nasopharyngeal swab or serology. All patients received intravenous immune globulin, with adjunctive steroid therapy used in a third. Three children were treated with an interleukin 1 receptor antagonist because of persistent severe inflammatory state, and 23 patients were treated with a therapeutic dose of heparin.

Outcomes were generally positive, according to the researchers, with left ventricular function restored in the 25 of 35 children discharged from the ICU. None of the patients died and all of the patients on ECMO were successfully weaned.

“Children may experience an acute cardiac decompensation due to severe inflammatory state following SARS-CoV-2 infection (multisystem inflammatory syndrome in children - MIS-C),” the authors conclude. “Treatment with immune globulin appears to be associated with recovery of left ventricular systolic function.”

"The majority of patients recovered within a few days following intravenous immune globulin, with adjunctive steroid therapy used in one third. Treatment with immune globulin appears to be associated with recovery of left ventricular systolic function," researchers revealed.