Objectives To describe the intensive care needs and outcome of multisystem inflammatory syndrome in children (MIS-C). Methodology This retrospective study was conducted in the pediatric emergency, pediatric intensive care unit (PICUs) and the coronavirus disease 2019 (COVID 19) hospital of a tertiary teaching and referral hospital in North India over a period of 5 months (September 2020 to January 2021). Clinical details, laboratory investigations, intensive care needs, treatment and short-term outcome were recorded. Results Forty children with median interquartile range age of 7 (5–10) years were enrolled. The common clinical features were fever (97.5%), mucocutaneous involvement (80%), abdominal (72.5%) and respiratory (50%) symptoms. Shock was noted in 80% children. Most cases (85%) required PICU admission where they received nasal prong oxygen (40%), non-invasive (22.5%) and invasive (22.5%) ventilation and vasoactive drug support (72.5%). The confirmation of severe acute respiratory syndrome coronavirus-2 (SARS-CoV-2) exposure was in the form of positive serology (66.7%), reverse transcriptase polymerase chain reaction (10%), and contact with SARS-CoV-2 positive case (12.5%). The common echocardiographic findings included myocardial dysfunction (ejection fraction <55%; 72.5%), and coronary artery dilatation or aneurysm (22.5%). The immunomodulatory treatment included intravenous immunoglobulin (2 g/kg) (100%) and steroids (methylprednisolone 10–30 mg/kg/day for 3–5 days) (85%). Aspirin was used in 80% and heparin (low molecular weight) in 7.5% cases. Two children died (5%) and median duration of PICU and hospital stay in survivors were 5 (2–8) and 7 (4–9) days, respectively. Children with shock showed higher total leucocyte count and higher rates of myocardial dysfunction. Conclusion Cardiovascular involvement and shock are predominant features in severe disease. Early diagnosis can be challenging given the overlapping features with other diagnoses. A high index of suspicion is warranted in children with constellation of fever, mucocutaneous, gastrointestinal and cardiovascular involvement alongwith evidence of systemic inflammation and recent or concurrent SARS-CoV-2 infection. The short-term outcome is good with appropriate organ support therapies and immunomodulation.

中文翻译：

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儿童多系统炎症综合征 (MIS-C) 的重症监护需求和短期结果：印度北部的经验

目的 描述儿童多系统炎症综合征 (MIS-C) 的重症监护需求和结果。方法 该回顾性研究在印度北部一家三级教学和转诊医院的儿科急诊、儿科重症监护病房 (PICU) 和 2019 年冠状病毒病 (COVID 19) 医院进行，为期 5 个月（2020 年 9 月至 2021 年 1 月） ）。记录临床细节、实验室检查、重症监护需求、治疗和短期结果。结果 40 名年龄中位数为 7 (5-10) 岁的儿童入选。常见的临床特征是发热（97.5%）、皮肤黏膜受累（80%）、腹部（72.5%）和呼吸道（50%）症状。80% 的儿童出现休克。大多数病例 (85%) 需要在 PICU 入院，他们接受鼻尖吸氧 (40%)、无创 (22.5%) 和有创 (22.5%) 通气和血管活性药物支持 (72.5%)。严重急性呼吸系统综合症冠状病毒2（SARS-CoV-2）暴露的确认形式为血清学阳性（66.7%）、逆转录聚合酶链反应（10%）和接触SARS-CoV-2阳性病例(12.5%)。常见的超声心动图检查结果包括心肌功能障碍（射血分数 <55%；72.5%）和冠状动脉扩张或动脉瘤（22.5%）。免疫调节治疗包括静脉注射免疫球蛋白（2 g/kg）（100%）和类固醇（甲基强的松龙 10-30 mg/kg/天，持续 3-5 天）（85%）。80% 使用阿司匹林，7.5% 使用肝素（低分子量）。两名儿童死亡（5%），幸存者中位 PICU 和住院时间分别为 5（2-8）天和 7（4-9）天。休克儿童表现出较高的总白细胞计数和较高的心肌功能障碍发生率。结论心血管受累和休克是重症患者的主要特征。鉴于与其他诊断的重叠特征，早期诊断可能具有挑战性。对于出现发烧、皮肤黏膜、胃肠道和心血管受累以及全身炎症和近期或同时感染 SARS-CoV-2 的证据的儿童，需要高度怀疑。适当的器官支持疗法和免疫调节的短期结果是好的。休克儿童表现出较高的总白细胞计数和较高的心肌功能障碍发生率。结论心血管受累和休克是重症患者的主要特征。鉴于与其他诊断的重叠特征，早期诊断可能具有挑战性。对于出现发烧、皮肤黏膜、胃肠道和心血管受累以及全身炎症和近期或同时感染 SARS-CoV-2 的证据的儿童，需要高度怀疑。适当的器官支持疗法和免疫调节的短期结果是好的。休克儿童表现出较高的总白细胞计数和较高的心肌功能障碍发生率。结论心血管受累和休克是重症患者的主要特征。鉴于与其他诊断的重叠特征，早期诊断可能具有挑战性。对于出现发烧、皮肤黏膜、胃肠道和心血管受累以及全身炎症和近期或同时感染 SARS-CoV-2 的证据的儿童，需要高度怀疑。适当的器官支持疗法和免疫调节的短期结果是好的。对于出现发烧、皮肤黏膜、胃肠道和心血管受累以及全身炎症和近期或同时感染 SARS-CoV-2 的证据的儿童，需要高度怀疑。适当的器官支持疗法和免疫调节的短期结果是好的。对于出现发烧、皮肤黏膜、胃肠道和心血管受累以及全身炎症和近期或同时感染 SARS-CoV-2 的证据的儿童，需要高度怀疑。适当的器官支持疗法和免疫调节的短期结果是好的。