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. 2021 Jan 27:8:2333794X21990339.
doi: 10.1177/2333794X21990339. eCollection 2021.

The "Golden Hours" Algorithm For the Management of the Multisystem Inflammatory Syndrome in Children (MIS-C)

Sanaa Mahmoud  1   2   3 , Eman M Fouda  2   3 , Alyaa Kotby  2   3 , Hanan M Ibrahim  2   3 , Mervat Gamal  2 , Yasmin G El Gendy  2 , Eman Ahmed Zaky  2 , Nermine H Amr  2 , Dalia H El-Ghoneimy  2   3 , Asmaa Aa Alsharkawy  2 , Ashraf Omar  2 , Mahmoud El-Meteini  2 , Mostafa Elhodhod  2   3
Affiliations

The "Golden Hours" Algorithm For the Management of the Multisystem Inflammatory Syndrome in Children (MIS-C)

Sanaa Mahmoud et al. Glob Pediatr Health. .

Abstract

The global concern of increasing number of children presenting with multisystem inflammatory syndrome in children (MIS-C) related to the coronavirus disease (COVID-19) has escalated the need for a case-oriented clinical approach that provides timely diagnosis and management. The aim of this study is to share our experience in managing 64 MIS-C patients of North African ethnicity guided by a risk-based algorithm. Sixty-four patients met the inclusion criteria, 19 (30%) patients were categorized as mild and moderate risk groups and cared for in an isolation ward and 45 patients who belonged to the high-risk group (70%) were admitted to the pediatric intensive care unit (PICU). Positive laboratory evidence of COVID-19 was found in 62 patients. Fever and dysfunction in 2 or more organs were confirmed in all cases (100%). Fifty patients (78%) presented with gastrointestinal symptoms, meanwhile only 10 patients (16%) had respiratory manifestations. Cardiac involvement was reported in 55 (86%) cases; hypotension and shock were found in 45 patients (70%) therein circulatory support and mechanical ventilations were needed for 45 and 13 patients respectively. Intravenous immunoglobulins (IVIG) were used for all cases and methylprednisolone was used in 60 patients (94%). Fifty-eight (91%) patients were discharged home after an average of 9 days of hospitalization. The mortality rate was 9% (6 patients). Conclusion. A single Egyptian center experience in the management of MIS-C patients guided by a proposed bed side algorithm is described. The algorithm proved to be a helpful tool for first-line responders, and helped initiate early treatment with IVIG.

Keywords: COVID-19; IVIG; Kawasaki disease; algorithm; pediatric MIS-C.

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Conflict of interest statement

Declaration of Conflicting Interests: The authors declared no potential conflicts of interest with respect to the research, authorship, and/or publication of this article.

Figures

Figure 1.
Figure 1.
MIS-C management based on risk criteria. Abbreviations: IVF, intravenous fluids; IV, intravenous; LDH, lactate dehydrogenase; CMP, comprehensive metabolic profile; PT, prothrombin time; PTT, partial thromboplastin time; CT, computed tomography.
Figure 2.
Figure 2.
MIS-C therapeutics.
See this image and copyright information in PMC

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