Nemours/A.I. duPont Hospital for Children is investigating another possible case of the mysterious Multisystem Inflammatory Syndrome in Children linked to COVID-19.
Nemours has treated three patients diagnosed with Multisystem Inflammatory Syndrome in Children, or MIS-C, in its ICU since mid-April. Alerts about the syndrome came from the U.K. and New York last month.
“COVID-19 is so rare and has been fortunately really mild in pediatrics, and we’re very fortunate to have been spared,” said Dr. Meg Frizzola, interim chair of pediatrics and chief of the pediatric critical care division at Nemours. “So as numbers are growing with this new entity, it’s really difficult to be certain the trend will hold true.”
The U.S. Centers for Disease Control and Prevention (CDC) defines MIS-C as fever, lab evidence of inflammation, involvement of two or more organ systems and recent COVID-19 infection or exposure. The World Health Organization (WHO) gives a similar preliminary case definition.
Commonly reported symptoms include abdominal pain, rash and low blood pressure. Frizzola says the cases treated at Nemours were “almost textbook.”
“Each one of our patients has had severe cardiac involvement including myocardial depression, as well as some coronary artery involvement,” she said. “They’ve had some form of respiratory failure. Some required mechanical ventilation and others required significant respiratory support in the form of high-flow nasal cannula.”
Two of Nemours’ MIS-C patients tested positive for the virus and one showed evidence of antibodies. An antibody test is pending on a possible fourth case.
Frizzola says the hospital has gathered more information on the syndrome from governmental health organizations and peer institutions over the last few weeks.
“We’re finding more and more consistent recommendations for therapies— what seems to have shown significant benefits, what protocols we should have developed,” she said. “We now have a very standard protocol that we are following.”
The World Health Organization has called for the collection of standardized data describing clinical presentations, severity, outcomes and epidemiology of MIS-C. Nemours has been sharing data about its MIS-C cases with peer institutions and regional public health officials, in line with guidance from the CDC. It has not yet begun contributing data to the global platform created by the WHO, but Frizzola says the hospital plans to do so.
Nemours has had success treating the syndrome with early IV immunoglobulin and steroids, Frizzola reports. All three of the patients formerly in the ICU have been discharged and are “doing well at home,” a hospital spokesperson said in an email.
“I think we’re contributing further evidence that what is being discussed is working in our patient population,” said Frizzola. “I don’t think we’ve trialed something that’s brand new that hasn’t been tried before.”
Frizzola says Nemours is also contributing to demographic trends in the syndrome; all the confirmed Delaware cases have involved teenage boys. Hospital officials say one patient was black, one was white and the third was Hispanic.
The WHO is advising doctors to consider MIS-C in children with features of typical or atypical Kawasaki disease or toxic shock syndrome. The CDC is advising doctors to consider MIS-C in any pediatric death with evidence of COVID-19 infection and report cases even if they fit full or partial criteria for Kawasaki disease.
Doctors at Nemours are taking a second look at recent cases of similar conditions.
“We actually pulled our database for all admissions from 2020 that we assigned a diagnosis of Kawasaki disease or toxic shock or macrophage activation system,” said Frizzola. “We are doing a deeper chart review and will likely have antibody testing done on many of those children.”
The hospital has noticed parents are hesitating to bring their children in during the pandemic. Officials warn this is not a good idea.
“They are keeping them at home and not calling, and they’re coming in a little bit sicker,” said Frizzola. “We’re urging and encouraging everyone to call their pediatrician with any concerns.”
Frizzola says the children’s hospital has social distancing protocols in place as well as personal protective equipment for staff and families of patients.
“We are safe, we are going to keep their patients safe as well as our providers safe,” Frizzola said. “It’s critical that families bring their children in for evaluation.”