Intravenous immunoglobulin versus methylprednisolone in multisystem inflammatory syndrome in children with COVID-19: an observational study

Ashfaq Masood; Vamiq Rasool; Mushtaq A. Bhat

doi:10.18203/2349-3291.ijcp20223289

Authors

Ashfaq Masood Department of Neonatology and Pediatrics, Sher I Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
Vamiq Rasool Department of Cardiology, Sher I Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India
Mushtaq A. Bhat Department of Neonatology and Pediatrics, Sher I Kashmir Institute of Medical Sciences, Srinagar, Jammu and Kashmir, India

DOI:

https://doi.org/10.18203/2349-3291.ijcp20223289

Keywords:

COVID-19 disease, MIS-C, Intravenous immunoglobulin, Methylprednisolone

Abstract

Background: Multisystem inflammatory syndrome in children (MIS-C) is temporally associated with SARS CoV 2 infection with a possible immune dysregulation. Presents with a multi organ involvement with dreaded complication of LV dysfunction and a long term sequalae of coronary involvement.

Methods: Prospective observational study of a cohort of 35 patients who fulfilled the CDC criteria for MIS-C. Demographic, clinical, lab, echocardiographic, treatment and outcome details were noted and analysed.

Results: The 35 children fulfilled CDC definition of MIS-C. Fever was present in 100% cases, rash in 62%, diarrhoea in 57%, RTI in 43%, hypotension in 43% and lymphadenopathy in 19% cases. The 23 patients had moderate MIS-C and 12 patients had severe MIS-C on admission. The 38% had normal contracting heart, 19% had dilated coronaries, 17% had mild LV dysfunction,12% had moderate LV dysfunction,12% had severe LV dysfunction, two patients had prolonged PR interval, one patient had AV block. Four patients had acute kidney injury; one patient had brachial vein thrombosis. 52% patients received combination of methylprednisolone and IVIG while 48% received only methylprednisolone. Defervescence was earlier in IVIG+MPS group compared to MPS group (1.72 days vs 2.8 days [p<0.05]). Improvement in LV dysfunction was earlier in IVIG+MPS group compared to MPS group (33 hours vs 40 hours, p<0.05). At 3 months followup Z score of coronaries was 1.9 (SD=0.125) in LMCA and 1.8 (SD=0.1) in LAD.

Conclusions: Patients treated with IVIG+MPS had better outcome compared to MPS only. Older children had more severe disease presentation. Coronary artery dilatation tends to improve with time.

Metrics

Metrics Loading ...

References

Rafferty MS, Burrows H, Joseph JP, Leveille J, Nihtianova S, Amirian ES. Multisystem inflammatory syndrome in children (MIS-C) and the coronavirus pandemic: Current knowledge and implications for public health. J Infect Publ Heal. 2021;14(4):484-94.

Riphagen S, Gomez X, Gonzalez-Martinez C, Wilkinson N, Theocharis P. Hyperinflammatory shock in children during COVID-19 pandemic. Lancet. 2020;395(10237):1607-8.

Royal College of Paediatrics and Child Health. Guidance: Paediatric multisystem inflammatory syndrome temporally associated with COVID-19. RCPCH. 2020.

Hennon TR, Penque MD, Abdul-Aziz R, Alibrahim OS, McGreevy MB, Prout AJ, et al. COVID-19 associated multisystem inflammatory syndrome in children (MIS-C) guidelines; a Western New York approach. Progress Pediatr Cardiol. 2020;57:101232.

DeBiasi RL, Song X, Delaney M, Bell M, Smith K, Pershad J, et al. Severe coronavirus disease-2019 in children and young adults in the Washington, DC, metropolitan region. J Pediatr. 2020;223:199-203.

Verdoni L, Mazza A, Gervasoni A, Martelli L, Ruggeri M, Ciuffreda M, et al. An outbreak of severe Kawasaki-like disease at the Italian epicentre of the SARS-CoV-2 epidemic: an observational cohort study. Lancet. 2020;395(10239):1771-8.

Newburger JW, Takahashi M, Gerber MA, Gewitz MH, Tani LY, Burns JC, et al. Diagnosis, treatment, and long-term management of Kawasaki disease: a statement for health professionals from the Committee on Rheumatic Fever, Endocarditis and Kawasaki Disease, Council on Cardiovascular Disease in the Young, American Heart Association. Circulation. 2004;110(17):2747-71.

Tissot C, Singh Y, Sekarski N. Echocardiographic evaluation of ventricular function-for the neonatologist and pediatric intensivist. Frontiers Pediatr. 2018;6:79.

Demography of Jammu and Kashmir State". J&K; Envis Centre, Department of Ecology Environment and Remote Sensing J&K. Available at: https://www.worldometers.info/world-population/ india-population/. Accessed on 22 February 2018.

Ministry of Health and Family Welfare J and K Statistics. 2021, Available at: https://main.mohfw. gov.bin/E-Citizen-and-Tender/csma/Jammu-nd-Kashmir. Accessed on 10 October 2022.

Levin M. Childhood multisystem inflammatory syndrome-a new challenge in the pandemic. N Eng J Med. 2020;383(4):393-5.

Dufort EM, Koumans EH, Chow EJ, Rosenthal EM, Muse A, Rowlands J, et al. Multisystem inflammatory syndrome in children in New York State. N Engl J Med. 2020;383:347-58.

Abrams JY, Oster ME, Godfred-Cato SE, Bryant B, Datta SD, Campbell AP, et al. Factors linked to severe outcomes in multisystem inflammatory syndrome in children (MIS-C) in the USA: a retrospective surveillance study. The Lancet Child & Adolescent Health. 2021;5(5):323-31.

Dionne A, Mah DY, Son MB, Lee PY, Henderson L, Baker AL, et al. Atrioventricular block in children with multisystem inflammatory syndrome. Pediatrics. 2020;146(5):e2020009704.