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Review
. 2021 May 26:9:667507.
doi: 10.3389/fped.2021.667507. eCollection 2021.

Best Practice Recommendations for the Diagnosis and Management of Children With Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2 (PIMS-TS; Multisystem Inflammatory Syndrome in Children, MIS-C) in Switzerland

Luregn J Schlapbach  1   2 , Maya C Andre  3   4 , Serge Grazioli  5 , Nina Schöbi  6   7 , Nicole Ritz  8 , Christoph Aebi  6 , Philipp Agyeman  6 , Manuela Albisetti  9 , Douggl G N Bailey  10 , Christoph Berger  11 , Géraldine Blanchard-Rohner  12 , Sabrina Bressieux-Degueldre  13 , Michael Hofer  12   14 , Arnaud G L'Huillier  12 , Mark Marston  3 , Patrick M Meyer Sauteur  11 , Jana Pachlopnik Schmid  15 , Marie-Helene Perez  16 , Bjarte Rogdo  10 , Johannes Trück  11   15 , Andreas Woerner  17 , Daniela Wütz  18 , Petra Zimmermann  19   20 , Michael Levin  21   22 , Elizabeth Whittaker  21   22 , Peter C Rimensberger  5 ; PIMS-TS working group of the Interest Group for Pediatric Neonatal Intensive Care (IGPNI) of the Swiss Society of Intensive Care and the Pediatric Infectious Diseases Group Switzerland (PIGS)
Affiliations
Review

Best Practice Recommendations for the Diagnosis and Management of Children With Pediatric Inflammatory Multisystem Syndrome Temporally Associated With SARS-CoV-2 (PIMS-TS; Multisystem Inflammatory Syndrome in Children, MIS-C) in Switzerland

Luregn J Schlapbach et al. Front Pediatr. .

Abstract

Background: Following the spread of the coronavirus disease 2019 (COVID-19) pandemic a new disease entity emerged, defined as Pediatric Inflammatory Multisystem Syndrome temporally associated with COVID-19 (PIMS-TS), or Multisystem Inflammatory Syndrome in Children (MIS-C). In the absence of trials, evidence for treatment remains scarce. Purpose: To develop best practice recommendations for the diagnosis and treatment of children with PIMS-TS in Switzerland. It is acknowledged that the field is changing rapidly, and regular revisions in the coming months are pre-planned as evidence is increasing. Methods: Consensus guidelines for best practice were established by a multidisciplinary group of Swiss pediatric clinicians with expertise in intensive care, immunology/rheumatology, infectious diseases, hematology, and cardiology. Subsequent to literature review, four working groups established draft recommendations which were subsequently adapted in a modified Delphi process. Recommendations had to reach >80% agreement for acceptance. Results: The group achieved agreement on 26 recommendations, which specify diagnostic approaches and interventions across anti-inflammatory, anti-infectious, and support therapies, and follow-up for children with suspected PIMS-TS. A management algorithm was derived to guide treatment depending on the phenotype of presentation, categorized into PIMS-TS with (a) shock, (b) Kawasaki-disease like, and (c) undifferentiated inflammatory presentation. Conclusion: Available literature on PIMS-TS is limited to retrospective or prospective observational studies. Informed by these cohort studies and indirect evidence from other inflammatory conditions in children and adults, as well as guidelines from international health authorities, the Swiss PIMS-TS recommendations represent best practice guidelines based on currently available knowledge to standardize treatment of children with suspected PIMS-TS. Given the absence of high-grade evidence, regular updates of the recommendations will be warranted, and participation of patients in trials should be encouraged.

Keywords: COVID-19; Kawasaki disease; MIS-C; child; multisystem inflammatory syndrome; pediatric inflammatory multisystem syndrome; septic shock.

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Conflict of interest statement

The authors declare that the research was conducted in the absence of any commercial or financial relationships that could be construed as a potential conflict of interest.

Figures

Figure 1
Figure 1
PIMS-TS diagnostic and therapeutic algorithm.
See this image and copyright information in PMC

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