■与SARS-CoV-2感染相关的多系统炎症综合征可导致儿童心肌损伤和休克,可能是严重炎症状态的结果,可以模仿川崎病。
■为了描述西班牙SARS-CoV-2大流行期间确诊或中止的COVID-19儿童的休克和心肌损伤的特征,包括临床表现,实验室和影像学发现,治疗,病程,和结果。提供了广泛的文献综述。
■回顾性病例系列,包括马德里儿科重症监护病房的所有儿童(1个月至18岁),西班牙,2020年3月15日至4月30日期间疑似或确诊SARS-CoV-2感染和休克。
■12名以前健康的休克患者,5至14岁,包括在内。所有需要的容量复苏和75%需要血管活性/正性肌力支持。入院时存在分布性休克的67%(n=8),4例(33%)有心源性休克特征。67%(n=8)诊断为心肌损伤,33%(n=4)诊断为心室功能障碍。最常见的症状是发烧(100%),厌食症(100%),腹泻(75%),呕吐(75%)。五名患者表现出川崎病的体征,但均未达到经典形式的标准。实验室发现淋巴细胞减少(83%),血小板减少症(83%),和增加的炎症标志物(100%)。呼吸状态没有显著影响。胸部X线检查显示双侧肺泡浸润7例(58%),双侧肺炎3例(25%)。11例(92%)确诊为COVID-19。所有人都接受了针对COVID-19的经验性治疗,血栓预防和免疫调节。在PICU和住院病房的平均停留时间为4.5天和10天,分别。没有患者死亡。
■COVID-19患儿的多系统炎症综合征可以模仿川崎病,并导致分布性休克和心源性休克的组合,可能继发于尚待精确定义的高炎症状态。治疗策略包括血液动力学支持,针对COVID-19的经验疗法,血栓预防,和免疫调节。
UNASSIGNED: Multisystem inflammatory syndrome associated with SARS-CoV-2 infection can lead to myocardial injury and shock in children, likely the result of a severe inflammatory state, and can mimic Kawasaki disease.
UNASSIGNED: To describe the characteristics of shock and myocardial injury in children with confirmed or suspeted COVID-19 during the SARS-CoV-2 pandemic in Spain, including clinical presentation, laboratory and imaging findings, treatment, disease course, and outcome. An extensive literature review is provided.
UNASSIGNED: Retrospective
case series including all children (age 1 month-18 years) admitted to a pediatric intensive care unit in Madrid, Spain, between March 15 and April 30, 2020 with suspected or confirmed SARS-CoV-2 infection and shock.
UNASSIGNED: Twelve previously healthy patients with shock, age 5 to 14 years, were included. All required volume resuscitation and 75% required vasoactive/inotropic support. Distributive shock was present on admission in 67% (n = 8), and 4 patients (33%) showed features of cardiogenic shock. Myocardial injury was diagnosed in 67% (n = 8) and ventricular dysfunction in 33% (n = 4). The most common symptoms on presentation were fever (100%), anorexia (100%), diarrhea (75%), and vomiting (75%). Five patients showed signs of Kawasaki disease but none met the criteria for the classic form. Laboratory findings revealed lymphopenia (83%), thrombocytopenia (83%), and increased inflammatory markers (100%). Respiratory status was not significantly impacted. Chest X-ray showed bilateral alveolar infiltrates in 7 (58%) and bilateral pneumonia in 3 (25%). COVID-19 was confirmed in 11 cases (92%). All received empirical therapy against COVID-19, thromboprophylaxis and immunomodulation. Median stay in the PICU and inpatient ward was 4.5 and 10 days, respectively. No patients died.
UNASSIGNED: Multisystem inflammatory syndrome in children with COVID-19 can mimic Kawasaki disease and lead to a combination of distributive and cardiogenic shock, probably secondary to a hyperinflammatory state that remains to be precisely defined. Treatment strategies include hemodynamic support, empirical therapies against COVID-19, thromboprophylaxis, and immunomodulation.