Materiały źródłowe

• #1 Multisystem Inflammatory Syndrome in Children (MIS-C) | Boston Children’s Hospital

  https://www.childrenshospital.org/conditions/mis-c

  Multisystem inflammatory syndrome in children (MIS-C), also called pediatric multi-system inflammatory syndrome temporally related to SARS CoV-2 (PMIS or PIMS-TS), is a potentially serious illness in children that appears to be a delayed, post-infectious complication of COVID-19 infection. […] Children with MIS-C need close observation by pediatric specialists in rheumatology, cardiology, critical care, and sometimes hematologists and infectious disease doctors. […] Children diagnosed with MIS-C need close observation. All need to be admitted to the hospital, and some may need intensive care. Pediatric specialists in rheumatology, critical care, and cardiology can anticipate and address different aspects of the illness. […] Treatments include IV immunoglobulin (used to treat Kawasaki disease), and anti-inflammatory drugs (corticosteroids, and drugs blocking IL-1 or IL-6). Other treatments may be used depending on the results of laboratory tests. Children are also treated with low-dose aspirin to decrease the risk of blood clots. […] Children need to be followed after discharge from the hospital, with repeat echocardiograms to monitor their heart and coronary arteries, even if they didn’t have serious problems in the hospital.

• #2 Multisystem Inflammatory Syndrome in Children (MIS-C) | Children’s Hospital of Philadelphia

  https://www.chop.edu/clinical-pathway/multisystem-inflammatory-syndrome-mis-c-clinical-pathway

  MIS-C occurs approximately 2-6 wks after the initial SARS-CoV-2 infection. […] When the disease is suspected, consult local experts in rheumatology, infectious disease, and cardiology to guide laboratory testing, diagnosis, and treatment. […] These clinical pathways are intended to be a guide for practitioners and may need to be adapted for each specific patient based on the practitioners professional judgment, consideration of any unique circumstances, the needs of each patient and their family, and/or the availability of various resources at the health care institution where the patient is located.

• #3 About MIS | MIS | CDC

  https://www.cdc.gov/mis/about/index.html

  Multisystem inflammatory syndrome (MIS) can affect children (MIS-C) and adults (MIS-A). […] MIS is a rare but serious condition associated with SARS-CoV-2, the virus that causes COVID-19, in which different internal and external body parts become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, and gastrointestinal tract. […] MIS can affect children (MIS-C) and adults (MIS-A). MIS-A is less common than MIS-C. Children with MIS-C appear to recover quickly from heart-related complications. […] Many children with MIS-C have had no or few symptoms of COVID-19. […] Most children with MIS-C do not have any reported underlying medical conditions. […] Of the children with MIS-C who do report an underlying medical condition, obesity is the most common. […] Based on what we know now, the best way to prevent MIS-C or MIS-A is to take actions to protect yourself from getting COVID-19, including COVID-19 vaccination for people 6 months and older.

• #4 Multisystem inflammatory syndrome in children (MIS-C) and COVID-19 – Symptoms and causes – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/mis-c-in-kids-covid-19/symptoms-causes/syc-20502550

  Multisystem inflammatory syndrome in children (MIS-C) is a group of symptoms linked to swollen, called inflamed, organs or tissues. People with MIS-C need care in the hospital. […] Most children who have MIS-C eventually get better with medical care. But some kids quickly get worse. MIS-C can cause life-threatening illness or death. […] The symptoms of MIS-C are serious and are treated in the hospital. Not all kids have the same symptoms. But if no other diagnosis fits, health care professionals may diagnose MIS-C if a child: […] If your child has any of the emergency warning signs listed above, or is severely sick with other symptoms, get care right away. […] The health care team may want to do tests to check for areas of inflammation and other signs of MIS-C. These may include blood tests, or imaging tests of the chest, heart or abdomen. […] Without early diagnosis and treatment, MIS-C can lead to severe problems with vital organs, such as the heart. In rare cases, MIS-C could lead to permanent damage or even death.

• #5 Multisystem inflammatory syndrome in children | NIH MedlinePlus Magazine

  https://magazine.medlineplus.gov/article/multisystem-inflammatory-syndrome-in-children

  Multisystem inflammatory syndrome is a set of symptoms associated with a rare but extreme immune response to COVID-19. […] A very small group of these kids go on to develop a serious set of symptomsan extremely rare condition called multisystem inflammatory syndrome in children, or MIS-C. […] Multisystem inflammatory syndrome (MIS) is a set of symptoms associated with an extreme immune response to COVID-19. It causes inflammation in multiple organs, including the heart, lungs, kidneys, brain, stomach, and intestines. […] Its a very rare conditiononly 2 out of 100,000 children develop itbut its serious and can be deadly. […] Children with MIS-C usually experience their first symptoms a few weeks after getting COVID-19. The most common symptoms are inflammation in more than two organs and a high fever (more than 100.4 degrees Fahrenheit) for 24 hours or longer.

• #6 Multisystem Inflammatory Syndrome In Children (MIS-C) Symptoms, Causes & Treatment

  https://my.clevelandclinic.org/health/diseases/24592-multisystem-inflammatory-syndrome-in-children

  Multisystem inflammatory syndrome in children (MIS-C) is a rare side effect of COVID-19. It causes inflammation in several parts of your child’s body. MIS-C can be life-threatening if symptoms are severe, so contact a healthcare provider if your child has signs of it. Treatment takes place in a hospital. Most children make a full recovery. […] Treatment for MIS-C may include: Receiving fluids from an IV (a needle placed into a vein in your child’s arm). Taking medications (oral or IV) to reduce inflammation (corticosteroids, immune globulin IVIG and glucocorticoids). Antiviral therapy (remdesivir) to treat COVID-19 if your child has an active infection. Receiving oxygen from an assisted breathing device (ventilator). Treatment focuses on reducing inflammation and preventing possible life-threatening symptoms. If your child has MIS-C, they’ll receive treatment in a hospital or a pediatric intensive care unit (PICU) depending on how severe their symptoms are.

• #7 SciELO Brazil – Multisystem Inflammatory Syndrome in Children (MIS-C) temporally related to COVID-19: the experience at a pediatric reference hospital in Colombia Multisystem Inflammatory Syndrome in Children (MIS-C) temporally related to COVID-19: the e

  https://www.scielo.br/j/rpp/a/FL8MSQtszPK5rbJ5gG8vKTJ/

  Objective: This study aimed to describe the clinical characteristics and the different phenotypes of children with multisystem inflammatory syndrome in children (MIS-C) temporally related to COVID-19 and to evaluate the risk conditions that favored a greater severity of the disease during a 12-month period at a pediatric reference hospital in Colombia. […] A total of 28 children presented MIS-C criteria. The median age was 7 years. Other than fever (100%) (onset 4 days prior to admission), the most frequent clinical features were gastrointestinal (86%) and mucocutaneous (61%). Notably, 14 (50%) children had Kawasaki-like symptoms. The most frequent echocardiographic abnormalities were pericardial effusion (64%), valvular involvement (68%), ventricular dysfunction (39%), and coronary artery abnormalities (29%). In addition, 75% had lymphopenia. All had at least one abnormal coagulation test. Most received intravenous immunoglobulin (89%), glucocorticoids (82%), vasopressors (54%), and antibiotics (64%). Notably, 61% had a more severe form of the disease and were admitted to an intensive care unit (median 4 days, mean 6 days); the severity predictors were patients with the inflammatory/MIS-C phenotype (OR 26.5; 95%CI 1.40503.7; p=0.029) and rash (OR 14.7; 95%CI 1.2178.7; p=0.034).

• #8

  https://emscimprovement.center/education-and-resources/toolkits/pediatric-disaster-preparedness-toolbox/covid-19-coronavirus/multi-inflammatory-syndrome-children-mis-c/

  Health officials are advising clinicians about a rare but serious inflammatory condition seen in children and linked to COVID-19. The Centers for Disease Control and Prevention (CDC) is calling the condition multisystem inflammatory syndrome in children (MIS-C) and is urging clinicians to report suspected cases so officials can learn more. […] Experts are shedding more light on a rare but serious inflammatory syndrome linked to COVID-19 that is affecting children. […] The Centers for Disease Control and Prevention (CDC) is providing background information on several cases of a recently reported multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19); and a case definition for this syndrome. CDC recommends healthcare providers report any patient who meets the case definition to local, state, and territorial health departments to enhance knowledge of risk factors, pathogenesis, clinical course, and treatment of this syndrome.

• #9 SciELO Brazil – Multisystem Inflammatory Syndrome in Children (MIS-C) temporally related to COVID-19: the experience at a pediatric reference hospital in Colombia Multisystem Inflammatory Syndrome in Children (MIS-C) temporally related to COVID-19: the e

  https://www.scielo.br/j/rpp/a/FL8MSQtszPK5rbJ5gG8vKTJ/

  Objective: This study aimed to describe the clinical characteristics and the different phenotypes of children with multisystem inflammatory syndrome in children (MIS-C) temporally related to COVID-19 and to evaluate the risk conditions that favored a greater severity of the disease during a 12-month period at a pediatric reference hospital in Colombia. […] A total of 28 children presented MIS-C criteria. The median age was 7 years. Other than fever (100%) (onset 4 days prior to admission), the most frequent clinical features were gastrointestinal (86%) and mucocutaneous (61%). Notably, 14 (50%) children had Kawasaki-like symptoms. The most frequent echocardiographic abnormalities were pericardial effusion (64%), valvular involvement (68%), ventricular dysfunction (39%), and coronary artery abnormalities (29%). In addition, 75% had lymphopenia. All had at least one abnormal coagulation test. Most received intravenous immunoglobulin (89%), glucocorticoids (82%), vasopressors (54%), and antibiotics (64%). Notably, 61% had a more severe form of the disease and were admitted to an intensive care unit (median 4 days, mean 6 days); the severity predictors were patients with the inflammatory/MIS-C phenotype (OR 26.5; 95%CI 1.40503.7; p=0.029) and rash (OR 14.7; 95%CI 1.2178.7; p=0.034).

• #10 Multisystem Inflammatory Syndrome in Children (MIS-C) | Children’s Healthcare of Atlanta

  https://www.choa.org/medical-services/infectious-diseases/mis-c

  Multisystem Inflammatory Syndrome in Children (MIS-C) is a condition that affects kids who previously had COVID-19. […] Multisystem Inflammatory Syndrome in Children (MIS-C) is a condition in which the heart, lungs, kidneys, brain, skin, eyes or abdominal organs become inflamed, according to the Centers for Disease Control and Prevention (CDC). It affects a very small number of children who have had COVID-19 or have been exposed to someone with COVID-19. […] Most children with MIS-C appear to be ill and do not act like themselves, showing signs of being extra tired. […] Contact your child’s pediatrician or seek medical care if your child’s pediatrician is not available. It is important for your child to see a doctor if you are worried about the way your child looks or is acting. […] If a doctor determines your child may have MIS-C, they may conduct tests to look for inflammation and other signs of MIS-C. These may include: Blood tests, X-rays, Echocardiogram (heart ultrasound), Abdominal ultrasound. […] Childrens continues to work with experts at the Georgia Department of Public Health (GDPH), CDC and other healthcare centers to learn more about MIS-C and how it affects a child’s health. Be sure to check back often as we update information about the syndrome.

• #11 Multisystem inflammatory syndrome in children (MIS-C) and COVID-19 – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/mis-c-in-kids-covid-19/diagnosis-treatment/drc-20502561

  Multisystem inflammatory syndrome in children (MIS-C) diagnosis is based on a child’s symptoms and on ruling out similar conditions. Lab tests can help this process. […] Children with MIS-C are treated in a hospital. Some need treatment in a pediatric intensive care unit. Treatment is supportive care and efforts to lower inflammation in any affected vital organs to protect them from permanent damage. Treatment depends on the type and severity of symptoms and which organs and other parts of the body are affected by inflammation. […] Supportive care may include: Fluids, if levels are too low, a condition called dehydration. Oxygen to help with breathing. Blood pressure medicines to treat low blood pressure related to shock or to help with heart function. A breathing machine called a ventilator. Medicines that lower the risk of blood clots, such as aspirin or heparin. In very rare cases, extracorporeal membrane oxygenation (ECMO) using a machine that does the work of the heart and lungs.

• #12 What is Multisystem Inflammatory Syndrome in Children (MIS-C)? – Children’s NationalClick to open the search input fieldPreviousNext

  https://riseandshine.childrensnational.org/what-is-multisystem-inflammatory-syndrome-in-children-mis-c/

  Multisystem Inflammatory Syndrome in Children (MIS-C) is a condition in which different body parts become inflamed, such as the heart, lungs, kidneys, brain, gastrointestinal tract, skin or eyes. […] Children with MIS-C can have a variety of symptoms, including: Fever, Abdominal Pain, Vomiting, Diarrhea, Neck Pain, Rash, Bloodshot Eyes, Feeling Extra Tired. […] If your child experiences the following more severe versions of MIS-C symptoms, you should seek emergency care immediately: Trouble breathing, Pain or pressure in the chest that does not go away, New confusion, Inability to wake or stay awake, Pale, gray, or blue-colored skin, lips, or nail beds, depending on skin, Severe abdominal pain. […] While MIS-C is a serious condition, with proper medical care most children are able to recover. If you have concerns your child is suffering from MIS-C, please call your primary care provider.

• #13 SciELO Brazil – Multisystem Inflammatory Syndrome in Children (MIS-C) temporally related to COVID-19: the experience at a pediatric reference hospital in Colombia Multisystem Inflammatory Syndrome in Children (MIS-C) temporally related to COVID-19: the e

  https://www.scielo.br/j/rpp/a/FL8MSQtszPK5rbJ5gG8vKTJ/

  Coronary artery abnormalities, ventricular dysfunction, and intensive care unit admission were frequent, which needs to highlight the importance of early clinical suspicion. […] The objective of this study was to describe the clinical and epidemiological characteristics and the different phenotypes of children with MIS-C and to evaluate the risk conditions associated with the worst prognosis and disease severity over a 12-month period at a pediatric reference hospital of a Latin American country with middle income (Colombia). […] In this study, the MIS-C cases were classified into three distinct clusters of clinical phenotypes: inflammatory/MIS-C phenotype (characterized by a cytokine storm, with greater organ involvement shock, gastrointestinal symptoms, elevated inflammatory markers, and cardiovascular compromise), a predominantly respiratory phenotype, and a Kawasaki-like phenotype.

• #14 Multi-inflammatory syndrome in children (MIS-C) associated with COVID-19: a nursing perspective experience report from a high-income tertiary paediatric hospital context

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9845810/

  The aims of this study were to describe the nursing status of children affected by hyperinflammation MIS-C disease and RNs experiences of caring for these children in paediatric inpatient hospital care. […] The RNs were frustrated by insufficient knowledge about MIS-C and that no one knew what to expect. Frustration was also related to the quick changes of the disease, feelings of inadequacy and coordination and communication in care. […] The RNs experienced the children with MIS-C as extremely ill. The illbeing comprised both physical and psychological elements. Children were perceived as having issues regarding pain, fever, swelling, thirst and fatigue, and they were unhappy and needed a lot of support. […] The RNs had a lot to think about regarding the complex drugs in care and they feared the risk of making mistakes.

• #15 What’s New

  https://www.cdph.ca.gov/Programs/CID/DCDC/Pages/COVID-19/MIS-C.aspx

  Most patients with MIS-C have a history of COVID-19 infections, often with few or no symptoms. The disease can start several weeks after the infection and most commonly starts with a new or returning fever. Other symptoms may include: rash, pink eye, abdominal pain, diarrhea, vomiting. […] While many of these symptoms are typical of other common pediatric illness, children with MIS-C will eventually become more severely ill. If you or your child develops these worsening symptoms you seek emergency medical care immediately: Trouble breathing, Pain or pressure in the chest that does not go away, Confusion or unusual behavior, Severe abdominal pain, Inability to wake or stay awake, Pale, gray, or blue-colored skin, lips, or nail beds (depending on skin tone). […] COVID-19 vaccinations can help protect your child from MIS-C. To keep your child safe, it’s important to make sure they get all their COVID-19 vaccines on time.

• #16 Multisystem Inflammatory Syndrome (MIS-C) in Children and COVID – What Nurses Should Know | Nurse.Org

  https://nurse.org/articles/mis-c-and-covid/

  Multisystem Inflammatory Syndrome (MIS-C) in Children and COVID – What Nurses Should Know […] MIS-C is a rare but severe hyperinflammatory condition in children and adolescents that typically occurs 26 weeks after a COVID-19 infection. […] Its important to educate patients and their families about the signs and symptoms of MIS-C. […] Currently, there is no single test to diagnose MIS-C. […] Much like there is no single test to diagnose MIS-C, there is no singular treatment for MIS-C. […] Due to the effect on multiple body systems, true healthcare collaboration is essential for treating patients with MIS-C. […] MIS-C remains a rare but possible deadly medical condition as a direct result of a COVID-19 infection despite the decreasing number of coronavirus infections.

• #17 Multisystem inflammatory syndrome in children (MIS-C) and COVID-19 – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/mis-c-in-kids-covid-19/diagnosis-treatment/drc-20502561

  Multisystem inflammatory syndrome in children (MIS-C) diagnosis is based on a child’s symptoms and on ruling out similar conditions. Lab tests can help this process. […] Children with MIS-C are treated in a hospital. Some need treatment in a pediatric intensive care unit. Treatment is supportive care and efforts to lower inflammation in any affected vital organs to protect them from permanent damage. Treatment depends on the type and severity of symptoms and which organs and other parts of the body are affected by inflammation. […] Supportive care may include: Fluids, if levels are too low, a condition called dehydration. Oxygen to help with breathing. Blood pressure medicines to treat low blood pressure related to shock or to help with heart function. A breathing machine called a ventilator. Medicines that lower the risk of blood clots, such as aspirin or heparin. In very rare cases, extracorporeal membrane oxygenation (ECMO) using a machine that does the work of the heart and lungs.

• #18 Clinical Treatment of Multisystem Inflammatory Syndrome in Children | MIS | CDC

  https://www.cdc.gov/mis/hcp/clinical-care-treatment/index.html

  Once a child has been diagnosed with multisystem inflammatory syndrome (MIS-C), they will be hospitalized and may receive care from a variety of specialists. […] Some children will need to be in the intensive care unit (ICU) to closely monitor symptoms. […] Depending on the child’s illness severity and manifestations, multiple specialists (e.g., cardiologists, critical care specialists, hematologists, infectious disease specialists, and rheumatologists) may participate in management. […] Laboratory testing for inflammatory markers (e.g., C-reactive protein) should be performed and may be repeated over the course of hospitalization to monitor response to treatment. […] Treatment generally involves the use of anti-inflammatory drugs. Anti-inflammatory measures have included the frequent use of intravenous immunoglobulin (IVIG) and steroid therapy.

• #19 Multisystem Inflammatory Syndrome in Children (MIS-C)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8938222/

  Clinicians must have a high clinical suspicion for this disorder in children who have had recent COVID-19 infection or exposure and present with a significant inflammatory response. Understanding of this disorder continues to evolve, and prompt diagnosis and treatment allow for the best possible outcome for patients with MIS-C. […] Gastrointestinal symptoms are a predominant clinical manifestation in MIS-C patients, and include abdominal pain, vomiting, and diarrhea. Viral illnesses causing these same symptoms are common in childhood, and MIS-C must be ruled out when there is a high clinical suspicion in a child who presents with recent COVID-19 infection or exposure, fever, and GI symptoms. […] The majority of patients with MIS-C present with lab findings indicative of overwhelming systemic inflammation. Elevated levels of C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), D-dimer, ferritin, procalcitonin, and lactate dehydrogenase are commonly seen.

• #20 Multisystem Inflammatory Syndrome in Children (MIS-C) – HAN

  https://www.chicagohan.org/covid-19/mis-c

  Hospital infection preventionists should be notified immediately upon recognition of patients meeting case definition to initiate public health reporting. […] A C-reactive protein 3.0 mg/dL (30 mg/L) is required for the CSTE/CDC MIS-C surveillance case definition. […] In suspected cases of MIS-C, strongly recommend the following additional laboratory testing due to the potential for myocardial involvement: BNP and Troponin. […] It is important to evaluate children with suspected MIS-C for alternative diagnoses particularly as MIS-C clinical manifestations overlap with those of other etiologies.

• #21 Multisystem inflammatory syndrome in children in Singapore – Annals Singapore

  https://annals.edu.sg/multisystem-inflammatory-syndrome-in-children-in-singapore/

  Multisystem inflammatory syndrome in children (MIS-C) is a rare inflammatory syndrome with multisystem involvement affecting children exposed to COVID-19. This condition is rarely reported in East Asia and was not detected in Singapore until 2021. We present 12 cases of MIS-C diagnosed in KK Womens and Childrens Hospital (KKH) from October 2021 to December 2021. […] We conducted an observational study on cases fulfilling the Singapore Ministry of Health criteria for MIS-C from January 2020 to December 2021 in KKH. Medical records were reviewed to obtain information on clinical presentation, disease course, treatment received and outcomes. […] In the 12 cases detected, the median age was 7.50 years (interquartile range 4.009.25); 8 were male. All patients had mucocutaneous symptoms similar to Kawasaki disease. Other commonly involved systems were: haematological (coagulopathy 100%, lymphopaenia 91.70% and thrombocytopaenia 75.00%), gastrointestinal (75.00%) and cardiovascular (83.30%). Six patients (50.00%) had shock and were admitted to the intensive care unit. Majority of patients received treatment within 2 days of hospitalisation with intravenous immunoglobulin (IVIg) and steroids. All survived; majority had normal echocardiograms and no long-term organ sequelae at 6 months post-discharge.

• #22 SciELO Brazil – Multisystem Inflammatory Syndrome in Children (MIS-C) temporally related to COVID-19: the experience at a pediatric reference hospital in Colombia Multisystem Inflammatory Syndrome in Children (MIS-C) temporally related to COVID-19: the e

  https://www.scielo.br/j/rpp/a/FL8MSQtszPK5rbJ5gG8vKTJ/

  Objective: This study aimed to describe the clinical characteristics and the different phenotypes of children with multisystem inflammatory syndrome in children (MIS-C) temporally related to COVID-19 and to evaluate the risk conditions that favored a greater severity of the disease during a 12-month period at a pediatric reference hospital in Colombia. […] A total of 28 children presented MIS-C criteria. The median age was 7 years. Other than fever (100%) (onset 4 days prior to admission), the most frequent clinical features were gastrointestinal (86%) and mucocutaneous (61%). Notably, 14 (50%) children had Kawasaki-like symptoms. The most frequent echocardiographic abnormalities were pericardial effusion (64%), valvular involvement (68%), ventricular dysfunction (39%), and coronary artery abnormalities (29%). In addition, 75% had lymphopenia. All had at least one abnormal coagulation test. Most received intravenous immunoglobulin (89%), glucocorticoids (82%), vasopressors (54%), and antibiotics (64%). Notably, 61% had a more severe form of the disease and were admitted to an intensive care unit (median 4 days, mean 6 days); the severity predictors were patients with the inflammatory/MIS-C phenotype (OR 26.5; 95%CI 1.40503.7; p=0.029) and rash (OR 14.7; 95%CI 1.2178.7; p=0.034).

• #23 Multisystem Inflammatory Syndrome in Children (MIS-C) – HAN

  https://www.chicagohan.org/covid-19/mis-c

  Hospital infection preventionists should be notified immediately upon recognition of patients meeting case definition to initiate public health reporting. […] A C-reactive protein 3.0 mg/dL (30 mg/L) is required for the CSTE/CDC MIS-C surveillance case definition. […] In suspected cases of MIS-C, strongly recommend the following additional laboratory testing due to the potential for myocardial involvement: BNP and Troponin. […] It is important to evaluate children with suspected MIS-C for alternative diagnoses particularly as MIS-C clinical manifestations overlap with those of other etiologies.

• #24 Multisystem Inflammatory Syndrome in Children (MIS-C) | Children’s Healthcare of Atlanta

  https://www.choa.org/medical-services/infectious-diseases/mis-c

  Multisystem Inflammatory Syndrome in Children (MIS-C) is a condition that affects kids who previously had COVID-19. […] Multisystem Inflammatory Syndrome in Children (MIS-C) is a condition in which the heart, lungs, kidneys, brain, skin, eyes or abdominal organs become inflamed, according to the Centers for Disease Control and Prevention (CDC). It affects a very small number of children who have had COVID-19 or have been exposed to someone with COVID-19. […] Most children with MIS-C appear to be ill and do not act like themselves, showing signs of being extra tired. […] Contact your child’s pediatrician or seek medical care if your child’s pediatrician is not available. It is important for your child to see a doctor if you are worried about the way your child looks or is acting. […] If a doctor determines your child may have MIS-C, they may conduct tests to look for inflammation and other signs of MIS-C. These may include: Blood tests, X-rays, Echocardiogram (heart ultrasound), Abdominal ultrasound. […] Childrens continues to work with experts at the Georgia Department of Public Health (GDPH), CDC and other healthcare centers to learn more about MIS-C and how it affects a child’s health. Be sure to check back often as we update information about the syndrome.

• #25 SciELO Brazil – Multisystem Inflammatory Syndrome in Children (MIS-C) temporally related to COVID-19: the experience at a pediatric reference hospital in Colombia Multisystem Inflammatory Syndrome in Children (MIS-C) temporally related to COVID-19: the e

  https://www.scielo.br/j/rpp/a/FL8MSQtszPK5rbJ5gG8vKTJ/

  Coronary artery abnormalities, ventricular dysfunction, and intensive care unit admission were frequent, which needs to highlight the importance of early clinical suspicion. […] The objective of this study was to describe the clinical and epidemiological characteristics and the different phenotypes of children with MIS-C and to evaluate the risk conditions associated with the worst prognosis and disease severity over a 12-month period at a pediatric reference hospital of a Latin American country with middle income (Colombia). […] In this study, the MIS-C cases were classified into three distinct clusters of clinical phenotypes: inflammatory/MIS-C phenotype (characterized by a cytokine storm, with greater organ involvement shock, gastrointestinal symptoms, elevated inflammatory markers, and cardiovascular compromise), a predominantly respiratory phenotype, and a Kawasaki-like phenotype.

• #26 Multisystem inflammatory syndrome in children in Singapore – Annals Singapore

  https://annals.edu.sg/multisystem-inflammatory-syndrome-in-children-in-singapore/

  The clinical presentation of our patients is similar to earlier reports, with some significant differences from Kawasaki disease. Multidisciplinary management, timely diagnosis, and early initiation of treatment with IVIg and steroids likely contributed to comparatively good outcomes. Our cases highlight the need for continued awareness of MIS-C among physicians, and surveillance of its incidence, short- and long-term outcomes. […] The management of MIS-C in our institution involves multidisciplinary care according to guidelines jointly formulated by the paediatric intensive care units of KKH and National University Hospital, Singapore. Prompt treatment of MIS-C with both IVIg and steroids are our first-line therapy, with high-dose steroids given to those with shock or end-organ disease.

• #27 Multisystem Inflammatory Syndrome in Children (MIS-C)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8938222/

  A multidisciplinary team approach, involving rheumatology, cardiology, hematology, and intensivists, is often necessary when caring for these patients. So far, favorable outcomes have been reported, with mortality rates of approximately 2%. However, the sequelae of MIS-C, particularly cardiovascular, in children and adolescents remain unknown.

• #28 Clinical Treatment of Multisystem Inflammatory Syndrome in Children | MIS | CDC

  https://www.cdc.gov/mis/hcp/clinical-care-treatment/index.html

  Once a child has been diagnosed with multisystem inflammatory syndrome (MIS-C), they will be hospitalized and may receive care from a variety of specialists. […] Some children will need to be in the intensive care unit (ICU) to closely monitor symptoms. […] Depending on the child’s illness severity and manifestations, multiple specialists (e.g., cardiologists, critical care specialists, hematologists, infectious disease specialists, and rheumatologists) may participate in management. […] Laboratory testing for inflammatory markers (e.g., C-reactive protein) should be performed and may be repeated over the course of hospitalization to monitor response to treatment. […] Treatment generally involves the use of anti-inflammatory drugs. Anti-inflammatory measures have included the frequent use of intravenous immunoglobulin (IVIG) and steroid therapy.

• #29 Clinical Treatment of Multisystem Inflammatory Syndrome in Children | MIS | CDC

  https://www.cdc.gov/mis/hcp/clinical-care-treatment/index.html

  Aspirin has commonly been used because of concerns for coronary artery involvement, and antibiotics are routinely used to treat potential sepsis while awaiting bacterial cultures. […] Evaluation and testing after hospitalization are based on the presentation and clinical course of each patient with MIS. […] Cardiology follow-up with repeat echocardiogram is generally recommended for patients with MIS cardiac manifestations. […] Follow-up with the patient’s primary care provider is important. A conversation between the patient, their guardian(s), and the clinical team or a specialist should occur to assist with decisions about COVID-19 vaccination after MIS. […] Most MIS-C patients have had good outcomes with no significant complications 1 year after diagnosis. […] The limited data that are available show that, for most patients, inflammatory markers and abnormal echocardiogram findings will normalize within 4 weeks after hospitalization. […] Most signs and symptoms resolve by 6 months; signs and symptoms persisting at 6 months have included muscular fatigue, abnormalities on neurologic exam, anxiety, and emotional difficulties.

• #30 Multisystem Inflammatory Syndrome in Children (MIS-C)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8938222/

  Due to the overlapping features commonly observed between MIS-C and Kawasaki disease, patients with MIS-C are currently treated empirically based on Kawasaki disease therapy protocols. The American College of Rheumatology has provided clinical practice guidelines for laboratory workup and management of patients with suspected MIS-C. […] Patients are recommended treatment with high-dose intravenous immunoglobulin (IVIG) at 2 gm/kg and glucocorticoids at~2 mg/kg/day in divided doses. […] Patients with severe clinical presentation (ICU admission, significant cardiovascular involvement, evidence of macrophage activation syndrome) are treated with methylprednisolone pulses (30 mg/kg/day3 days) followed by glucocorticoids (~2 mg/kg/day in divided doses). […] Anakinra has a favorable safety profile and a relatively short half-life (approximately 46 h), making it a desirable therapeutic agent, as it can be quickly stopped if side effects occur.

• #31 MIS-C and COVID-19 in Children | Children’s Hospital Colorado

  https://www.childrenscolorado.org/conditions-and-advice/conditions-and-symptoms/conditions/mis-c-covid-19-in-children/

  Yes. MIS-C can be serious, even deadly, but most children who were diagnosed with this condition have gotten better with medical care. […] Childrens Hospital Colorado has seen and treated cases of MIS-C. Fortunately, parents can be reassured that MIS-C is rare and there are existing treatments that have been successful in making kids better. […] Doctors may provide supportive care for symptoms (medicine and/or fluids to make your child feel better) and may use immune globulin (IVIG), infliximab, steroids or other medications that strengthen the immune system that are used for Kawasaki disease and toxic shock syndrome. […] Most children who become ill with MIS-C will need to be treated in the hospital. Some will need to be treated in the Pediatric Intensive Care Unit (PICU). […] Children who have recovered from MIS-C should receive checkups at 2 weeks and 6 weeks after they leave the hospital. […] During the visit, doctors will take samples for laboratory testing and will perform an echocardiogram to check on the patients heart. This is to ensure that the child has healed and is returning to normal health.

• #32 Multisystem inflammatory syndrome in children (MIS-C) and COVID-19 – Diagnosis and treatment – Mayo Clinic

  https://www.mayoclinic.org/diseases-conditions/mis-c-in-kids-covid-19/diagnosis-treatment/drc-20502561

  Multisystem inflammatory syndrome in children (MIS-C) diagnosis is based on a child’s symptoms and on ruling out similar conditions. Lab tests can help this process. […] Children with MIS-C are treated in a hospital. Some need treatment in a pediatric intensive care unit. Treatment is supportive care and efforts to lower inflammation in any affected vital organs to protect them from permanent damage. Treatment depends on the type and severity of symptoms and which organs and other parts of the body are affected by inflammation. […] Supportive care may include: Fluids, if levels are too low, a condition called dehydration. Oxygen to help with breathing. Blood pressure medicines to treat low blood pressure related to shock or to help with heart function. A breathing machine called a ventilator. Medicines that lower the risk of blood clots, such as aspirin or heparin. In very rare cases, extracorporeal membrane oxygenation (ECMO) using a machine that does the work of the heart and lungs.

• #33 Multisystem inflammatory syndrome in children (MIS-C) – Children’s Health Cardiology

  https://www.childrens.com/specialties-services/conditions/multisystem-inflammatory-syndrome-in-children

  Most children diagnosed with MIS-C were previously healthy or had mild conditions like mild asthma or allergies. Many children did not show signs of COVID-19 at the time of infection, but later developed MIS-C. MIS-C can occur 2-6 weeks after infection. […] There is no cure for MIS-C, but the experts at Children’s Health have developed a comprehensive approach to treating it. Multiple specialists collaborate to provide all the care your child needs. Your child will receive care that helps support the damaged organs. Usually, children need to be in the intensive care unit (ICU). Without this care, MIS-C can be life-threatening. […] Most children with MIS-C need supportive care to help their damaged organs function while their body heals. This might include: Extra fluids to support blood pressure, Medicines to raise low blood pressure and help the heart pump more strongly, Extra oxygen to ensure oxygen gets to all organs.

• #34 Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19

  https://ceufast.com/course/multisystem-inflammatory-syndrome-in-children-mis-c-associated-with-covid-19

  The most significant risk factor, however, is infection with COVID-19, with 98% of cases having a positive test for SARS-CoV-2 and the other 2% testing negative but having a close contact who is positive. Therefore, mitigation of risk is best aimed at reducing risk of viral infection. […] Nurses working in acute care settings like emergency departments and inpatient pediatric units or intensive care units (ICUs) may encounter children who are more obviously and acutely ill with MIS-C. Nurses should be highly suspicious of the disease with children who present with severe abdominal symptoms, hemodynamic instability, cardiac dysfunction, severely elevated inflammatory labs, or shock. […] For children in which MIS-C has been identified, nursing care will involve support of vital signs, possible use of mechanical ventilation or ECMO, and administration of various medications to treat hypotension, cardiac dysfunction, and hyperinflammation.

• #35 Clinical Treatment of Multisystem Inflammatory Syndrome in Children | MIS | CDC

  https://www.cdc.gov/mis/hcp/clinical-care-treatment/index.html

  Aspirin has commonly been used because of concerns for coronary artery involvement, and antibiotics are routinely used to treat potential sepsis while awaiting bacterial cultures. […] Evaluation and testing after hospitalization are based on the presentation and clinical course of each patient with MIS. […] Cardiology follow-up with repeat echocardiogram is generally recommended for patients with MIS cardiac manifestations. […] Follow-up with the patient’s primary care provider is important. A conversation between the patient, their guardian(s), and the clinical team or a specialist should occur to assist with decisions about COVID-19 vaccination after MIS. […] Most MIS-C patients have had good outcomes with no significant complications 1 year after diagnosis. […] The limited data that are available show that, for most patients, inflammatory markers and abnormal echocardiogram findings will normalize within 4 weeks after hospitalization. […] Most signs and symptoms resolve by 6 months; signs and symptoms persisting at 6 months have included muscular fatigue, abnormalities on neurologic exam, anxiety, and emotional difficulties.

• #36 Multi-inflammatory syndrome in children (MIS-C) associated with COVID-19: a nursing perspective experience report from a high-income tertiary paediatric hospital context

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9845810/

  In the midst of the COVID-19 coronavirus pandemic, a new disease that affects children has arisen called multisystem inflammatory syndrome in children (MIS-C). Several research articles focusing on its medical aspects have been published, but very few have focused on nursing care. The aim of this study was therefore to describe the nursing status of children suffering from MIS-C and the experiences of registered nurses (RNs) in caring for these children in paediatric hospital inpatient care. […] When caring for children with MIS-C, nurses experienced frustration over uncertainty of care, childrens illbeing and unavoidable procedures. […] One important factor when caring for these children was the use of a central venous line early in the care process, which improved the quality of care. Moreover, the care of children suffering from MIS-C demands resources and time from healthcare professionals, especially RNs, to meet caring needs and reduce illbeing.

• #37 Multi-inflammatory syndrome in children (MIS-C) associated with COVID-19: a nursing perspective experience report from a high-income tertiary paediatric hospital context

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9845810/

  The aims of this study were to describe the nursing status of children affected by hyperinflammation MIS-C disease and RNs experiences of caring for these children in paediatric inpatient hospital care. […] The RNs were frustrated by insufficient knowledge about MIS-C and that no one knew what to expect. Frustration was also related to the quick changes of the disease, feelings of inadequacy and coordination and communication in care. […] The RNs experienced the children with MIS-C as extremely ill. The illbeing comprised both physical and psychological elements. Children were perceived as having issues regarding pain, fever, swelling, thirst and fatigue, and they were unhappy and needed a lot of support. […] The RNs had a lot to think about regarding the complex drugs in care and they feared the risk of making mistakes.

• #38 Multi-inflammatory syndrome in children (MIS-C) associated with COVID-19: a nursing perspective experience report from a high-income tertiary paediatric hospital context | Pediatric Rheumatology | Full Text

  https://ped-rheum.biomedcentral.com/articles/10.1186/s12969-023-00786-y

  The aims of this study were to describe the nursing status of children affected by hyperinflammation MIS-C disease and RNs experiences of caring for these children in paediatric inpatient hospital care. […] The RNs were concerned about the childrens circulation status, which often drew their attention. High fever and swelling were major concerns that needed the nurses consideration and/or treatment with medicine. […] The RNs described the administration of drugs for children with MIS-C as stressful. […] The RNs described elimination control challenges for children without urine catheters. […] The RNs described that the children were angry or agitated, which also relates to the neurological manifest symptoms that MIS-C has, which complicates nursing care further. […] The RNs experienced the children with MIS-C as extremely ill. The illbeing comprised both physical and psychological elements. Children were perceived as having issues regarding pain, fever, swelling, thirst and fatigue, and they were unhappy and needed a lot of support.

• #39 Multi-inflammatory syndrome in children (MIS-C) associated with COVID-19: a nursing perspective experience report from a high-income tertiary paediatric hospital context | Pediatric Rheumatology | Full Text

  https://ped-rheum.biomedcentral.com/articles/10.1186/s12969-023-00786-y

  The large number of needle-related procedures in the care of these children was very difficult for the children and frustrating and challenging for the RNs. […] The RNs had a lot to think about regarding the complex drugs in care and they feared the risk of making mistakes. […] The results show that children suffering from MIS-C have many different areas of nursing focus, which challenges RNs and other professionals in paediatric hospital care. RNs, together with the interprofessional team, should pay attention to the quick changes in childrens health status. The care of children suffering from MIS-C demands resources and time from HCPs, especially RNs, to be able to meet the childrens needs and reduce their illbeing.

• #40 Multi-inflammatory syndrome in children (MIS-C) associated with COVID-19: a nursing perspective experience report from a high-income tertiary paediatric hospital context

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9845810/

  The results show that children suffering from MIS-C have many different areas of nursing focus, which challenges RNs and other professionals in paediatric hospital care. RNs, together with the interprofessional team, should pay attention to the quick changes in childrens health status. The care of children suffering from MIS-C demands resources and time from HCPs, especially RNs, to be able to meet the childrens needs and reduce their illbeing.

• #41 Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19

  https://ceufast.com/course/multisystem-inflammatory-syndrome-in-children-mis-c-associated-with-covid-19

  The most significant risk factor, however, is infection with COVID-19, with 98% of cases having a positive test for SARS-CoV-2 and the other 2% testing negative but having a close contact who is positive. Therefore, mitigation of risk is best aimed at reducing risk of viral infection. […] Nurses working in acute care settings like emergency departments and inpatient pediatric units or intensive care units (ICUs) may encounter children who are more obviously and acutely ill with MIS-C. Nurses should be highly suspicious of the disease with children who present with severe abdominal symptoms, hemodynamic instability, cardiac dysfunction, severely elevated inflammatory labs, or shock. […] For children in which MIS-C has been identified, nursing care will involve support of vital signs, possible use of mechanical ventilation or ECMO, and administration of various medications to treat hypotension, cardiac dysfunction, and hyperinflammation.

• #42 Multi-inflammatory syndrome in children (MIS-C) associated with COVID-19: a nursing perspective experience report from a high-income tertiary paediatric hospital context

  https://pmc.ncbi.nlm.nih.gov/articles/PMC9845810/

  In the midst of the COVID-19 coronavirus pandemic, a new disease that affects children has arisen called multisystem inflammatory syndrome in children (MIS-C). Several research articles focusing on its medical aspects have been published, but very few have focused on nursing care. The aim of this study was therefore to describe the nursing status of children suffering from MIS-C and the experiences of registered nurses (RNs) in caring for these children in paediatric hospital inpatient care. […] When caring for children with MIS-C, nurses experienced frustration over uncertainty of care, childrens illbeing and unavoidable procedures. […] One important factor when caring for these children was the use of a central venous line early in the care process, which improved the quality of care. Moreover, the care of children suffering from MIS-C demands resources and time from healthcare professionals, especially RNs, to meet caring needs and reduce illbeing.

• #43

  https://www.nursingcenter.com/cearticle?an=00000446-202105000-00023&Journal_ID=54030&Issue_ID=5835877

  Because its presenting signs and symptoms can be subtle, MIS-C can be mistaken for mild viral illness or gastroenteritis. Children with a viral prodrome of fever, GI upset, irritability, and other nonspecific symptoms should be referred for evaluation by a pediatric provider. […] The discharge planning process should ensure adequate access to long-term medication needs and to primary and specialty care. Follow-up within 24 to 72 hours after discharge is recommended. […] Long-term follow-up for GI sequelae may be indicated, as some children may require surveillance for inflammatory bowel disease. […] Cardiac follow-up care can vary. In cases of Kawasaki disease it’s recommended that ECHO be repeated one to two weeks and four to six weeks after treatment for an uncomplicated course. […] Similarly, the ACR clinical guidance document for children with MIS-C recommends repeating ECHO at a minimum of one to two weeks and four to six weeks after presentation; an additional ECHO one year after diagnosis should be considered in cases of MIS-C with associated cardiac abnormalities.

• #44 Multi-inflammatory syndrome in children (MIS-C) associated with COVID-19: a nursing perspective experience report from a high-income tertiary paediatric hospital context | Pediatric Rheumatology | Full Text

  https://ped-rheum.biomedcentral.com/articles/10.1186/s12969-023-00786-y

  The large number of needle-related procedures in the care of these children was very difficult for the children and frustrating and challenging for the RNs. […] The RNs had a lot to think about regarding the complex drugs in care and they feared the risk of making mistakes. […] The results show that children suffering from MIS-C have many different areas of nursing focus, which challenges RNs and other professionals in paediatric hospital care. RNs, together with the interprofessional team, should pay attention to the quick changes in childrens health status. The care of children suffering from MIS-C demands resources and time from HCPs, especially RNs, to be able to meet the childrens needs and reduce their illbeing.

• #45 Clinical Treatment of Multisystem Inflammatory Syndrome in Children | MIS | CDC

  https://www.cdc.gov/mis/hcp/clinical-care-treatment/index.html

  Aspirin has commonly been used because of concerns for coronary artery involvement, and antibiotics are routinely used to treat potential sepsis while awaiting bacterial cultures. […] Evaluation and testing after hospitalization are based on the presentation and clinical course of each patient with MIS. […] Cardiology follow-up with repeat echocardiogram is generally recommended for patients with MIS cardiac manifestations. […] Follow-up with the patient’s primary care provider is important. A conversation between the patient, their guardian(s), and the clinical team or a specialist should occur to assist with decisions about COVID-19 vaccination after MIS. […] Most MIS-C patients have had good outcomes with no significant complications 1 year after diagnosis. […] The limited data that are available show that, for most patients, inflammatory markers and abnormal echocardiogram findings will normalize within 4 weeks after hospitalization. […] Most signs and symptoms resolve by 6 months; signs and symptoms persisting at 6 months have included muscular fatigue, abnormalities on neurologic exam, anxiety, and emotional difficulties.

• #46

  https://www.nursingcenter.com/cearticle?an=00000446-202105000-00023&Journal_ID=54030&Issue_ID=5835877

  Because its presenting signs and symptoms can be subtle, MIS-C can be mistaken for mild viral illness or gastroenteritis. Children with a viral prodrome of fever, GI upset, irritability, and other nonspecific symptoms should be referred for evaluation by a pediatric provider. […] The discharge planning process should ensure adequate access to long-term medication needs and to primary and specialty care. Follow-up within 24 to 72 hours after discharge is recommended. […] Long-term follow-up for GI sequelae may be indicated, as some children may require surveillance for inflammatory bowel disease. […] Cardiac follow-up care can vary. In cases of Kawasaki disease it’s recommended that ECHO be repeated one to two weeks and four to six weeks after treatment for an uncomplicated course. […] Similarly, the ACR clinical guidance document for children with MIS-C recommends repeating ECHO at a minimum of one to two weeks and four to six weeks after presentation; an additional ECHO one year after diagnosis should be considered in cases of MIS-C with associated cardiac abnormalities.

• #47

  https://www.nursingcenter.com/cearticle?an=00000446-202105000-00023&Journal_ID=54030&Issue_ID=5835877

  Because its presenting signs and symptoms can be subtle, MIS-C can be mistaken for mild viral illness or gastroenteritis. Children with a viral prodrome of fever, GI upset, irritability, and other nonspecific symptoms should be referred for evaluation by a pediatric provider. […] The discharge planning process should ensure adequate access to long-term medication needs and to primary and specialty care. Follow-up within 24 to 72 hours after discharge is recommended. […] Long-term follow-up for GI sequelae may be indicated, as some children may require surveillance for inflammatory bowel disease. […] Cardiac follow-up care can vary. In cases of Kawasaki disease it’s recommended that ECHO be repeated one to two weeks and four to six weeks after treatment for an uncomplicated course. […] Similarly, the ACR clinical guidance document for children with MIS-C recommends repeating ECHO at a minimum of one to two weeks and four to six weeks after presentation; an additional ECHO one year after diagnosis should be considered in cases of MIS-C with associated cardiac abnormalities.

• #48

  https://www.nursingcenter.com/cearticle?an=00000446-202105000-00023&Journal_ID=54030&Issue_ID=5835877

  Because its presenting signs and symptoms can be subtle, MIS-C can be mistaken for mild viral illness or gastroenteritis. Children with a viral prodrome of fever, GI upset, irritability, and other nonspecific symptoms should be referred for evaluation by a pediatric provider. […] The discharge planning process should ensure adequate access to long-term medication needs and to primary and specialty care. Follow-up within 24 to 72 hours after discharge is recommended. […] Long-term follow-up for GI sequelae may be indicated, as some children may require surveillance for inflammatory bowel disease. […] Cardiac follow-up care can vary. In cases of Kawasaki disease it’s recommended that ECHO be repeated one to two weeks and four to six weeks after treatment for an uncomplicated course. […] Similarly, the ACR clinical guidance document for children with MIS-C recommends repeating ECHO at a minimum of one to two weeks and four to six weeks after presentation; an additional ECHO one year after diagnosis should be considered in cases of MIS-C with associated cardiac abnormalities.

• #49 Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19

  https://ceufast.com/course/multisystem-inflammatory-syndrome-in-children-mis-c-associated-with-covid-19

  Once patients have been stabilized and acute illness has passed, close follow-up is needed to track the return of inflammatory markers back to normal, monitor cardiac function and resolution of coronary artery dilation, and assess for any lasting organ dysfunction or damage. […] The current recommendation is for all children ages 6 months and older to receive an initial COVID-19 vaccine and at least 1 updated vaccine. […] Early identification of MIS-C is also an important nursing intervention. For children who are seen in the pediatric office with mild or even asymptomatic COVID-19, parents should be educated about signs and symptoms to be aware of in the coming weeks and when to seek further evaluation.

• #50

  https://www.healthychildren.org/English/health-issues/conditions/COVID-19/Pages/covid_inflammatory_condition.aspx

  MIS-C can cause the wall of the heart to be inflamed (myocarditis). Patients with myocarditis will be restricted from activities like exercise or sports for a period of time. […] Yes, all children who are eligible should receive the recommended dose or doses of COVID vaccine. […] The best way to prevent MIS-C is for all eligible children age 6 months and up to get the updated COVID vaccine. […] While MIS-C sounds frightening, it is very rare.

• #51 Multisystem inflammatory syndrome in children (MIS-C) – Children’s Health Cardiology

  https://www.childrens.com/specialties-services/conditions/multisystem-inflammatory-syndrome-in-children

  Your child’s doctor might also use medicines that can calm an overactive immune system and reduce inflammation. These medicines have been used in other conditions with overactive immune system in children, like Kawasaki disease. They include: Steroids, IV immunoglobulin, Anakinra (Kineret). […] Some children with MIS-C will need blood thinners because COVID-19 and related-illnesses like MIS-C can cause blood clots. Blood thinners help prevent blood clots, which can cause strokes or blockages in the lungs. […] Most children with MIS-C spend 7-10 days in the hospital, including 3-4 days in the ICU, but some severe cases need more time to improve. Fortunately, most children bounce back quickly after treatment. However, they may need to limit physical activity until a heart doctor clears them.

• #52 Multisystem inflammatory syndrome in children (MIS-C)

  https://www.aboutkidshealth.ca/multisystem-inflammatory-syndrome-in-children-mis-c

  Most children recover quickly and can go home from the hospital after a few days. Your child may need to continue taking medications at home such as aspirin and/or corticosteroids. […] Children diagnosed with MIS-C need follow-up in a multidisciplinary clinic where they will have repeat bloodwork, monitoring of their heart and assessment by a specialized team.

• #53 COVID-19 and Multisystem Inflammatory Syndrome in Children (MIS-C) (for Parents) | Nemours KidsHealth

  https://kidshealth.org/en/parents/pmis.html

  MIS-C can cause different problems in different kids. The inflammation can affect the heart, blood cells, blood vessels, skin, digestive system, or eyes. Sometimes, this can damage the organs, especially the heart. […] How doctors treat MIS-C depends on a child’s symptoms and test results. They can give oxygen, medicines, and intravenous (IV) fluids to reduce inflammation, prevent excessive blood clotting, or protect the affected organs from more problems. Some children might need treatment in the ICU (intensive care unit). […] Most kids with MIS-C get better after being treated in the hospital. But some can have lasting problems and need care from specialists after they go home. […] For example, kids who develop heart problems due to MIS-C will need regular visits with a cardiologist. They may have to avoid exercise or sports for a while, until the cardiologist says it’s OK. Kids who get some kinds medicines (like steroids for easing inflammation) will see a specialist, such as a rheumatologist or endocrinologist, who can help them adjust their medicines as needed.

• #54

  https://www.nursingcenter.com/cearticle?an=00000446-202105000-00023&Journal_ID=54030&Issue_ID=5835877

  Because its presenting signs and symptoms can be subtle, MIS-C can be mistaken for mild viral illness or gastroenteritis. Children with a viral prodrome of fever, GI upset, irritability, and other nonspecific symptoms should be referred for evaluation by a pediatric provider. […] The discharge planning process should ensure adequate access to long-term medication needs and to primary and specialty care. Follow-up within 24 to 72 hours after discharge is recommended. […] Long-term follow-up for GI sequelae may be indicated, as some children may require surveillance for inflammatory bowel disease. […] Cardiac follow-up care can vary. In cases of Kawasaki disease it’s recommended that ECHO be repeated one to two weeks and four to six weeks after treatment for an uncomplicated course. […] Similarly, the ACR clinical guidance document for children with MIS-C recommends repeating ECHO at a minimum of one to two weeks and four to six weeks after presentation; an additional ECHO one year after diagnosis should be considered in cases of MIS-C with associated cardiac abnormalities.

• #55 Clinical Treatment of Multisystem Inflammatory Syndrome in Children | MIS | CDC

  https://www.cdc.gov/mis/hcp/clinical-care-treatment/index.html

  Aspirin has commonly been used because of concerns for coronary artery involvement, and antibiotics are routinely used to treat potential sepsis while awaiting bacterial cultures. […] Evaluation and testing after hospitalization are based on the presentation and clinical course of each patient with MIS. […] Cardiology follow-up with repeat echocardiogram is generally recommended for patients with MIS cardiac manifestations. […] Follow-up with the patient’s primary care provider is important. A conversation between the patient, their guardian(s), and the clinical team or a specialist should occur to assist with decisions about COVID-19 vaccination after MIS. […] Most MIS-C patients have had good outcomes with no significant complications 1 year after diagnosis. […] The limited data that are available show that, for most patients, inflammatory markers and abnormal echocardiogram findings will normalize within 4 weeks after hospitalization. […] Most signs and symptoms resolve by 6 months; signs and symptoms persisting at 6 months have included muscular fatigue, abnormalities on neurologic exam, anxiety, and emotional difficulties.

• #56 COVID-19 and Multisystem Inflammatory Syndrome in Children (MIS-C) | FCEP

  https://fcep.org/covid-19-and-multisystem-inflammatory-syndrome-in-children-mis-c/

  Management of MIS-C patients depends on the severity of their presentation. Patients presenting with shock should be resuscitated per standard protocols, recognizing that many patients with shock in recent reports required inotropic support (47-80%) in addition to fluid resuscitation. […] Considering the multisystem effects, organizing a multi-disciplinary team to co-manage the patient is critical. […] MIS-C is a new entity and much remains to be determined regarding the pathophysiology, clinical findings, management and prognosis. Early recognition is critical as appropriate management with existing therapies does appear to result in good outcomes in many cases. The long-term prognosis of MIS-C is currently unknown.

• #57 Multisystem inflammatory syndrome in children – Wikipedia

  https://en.wikipedia.org/wiki/Multisystem_inflammatory_syndrome_in_children

  All affected children have persistent fever. Other clinical features vary. The first symptoms often include acute abdominal pain with diarrhea or vomiting. Muscle pain and general fatigue are frequent, and low blood pressure is also common. Symptoms can also include pink eye, rashes, enlarged lymph nodes, swollen hands and feet, and „strawberry tongue”. Various mental disturbances are possible. A cytokine storm may take place, in which the child’s innate immune system stages an excessive and uncontrolled inflammatory response. Heart failure is common. Clinical complications can include damage to the heart muscle, respiratory distress, acute kidney injury, and increased blood coagulation. Coronary artery abnormalities can develop (ranging from dilatation to aneurysms). […] This life-threatening disease has proved fatal in under 2% of reported cases. Early recognition and prompt specialist attention are essential. Anti-inflammatory treatments have been used, with good responses being recorded for intravenous immunoglobulin (IVIG), with or without corticosteroids. Oxygen is often needed. Supportive care is key for treating clinical complications. Most children who receive expert hospital care survive.

• #58 Clinical Treatment of Multisystem Inflammatory Syndrome in Children | MIS | CDC

  https://www.cdc.gov/mis/hcp/clinical-care-treatment/index.html

  Aspirin has commonly been used because of concerns for coronary artery involvement, and antibiotics are routinely used to treat potential sepsis while awaiting bacterial cultures. […] Evaluation and testing after hospitalization are based on the presentation and clinical course of each patient with MIS. […] Cardiology follow-up with repeat echocardiogram is generally recommended for patients with MIS cardiac manifestations. […] Follow-up with the patient’s primary care provider is important. A conversation between the patient, their guardian(s), and the clinical team or a specialist should occur to assist with decisions about COVID-19 vaccination after MIS. […] Most MIS-C patients have had good outcomes with no significant complications 1 year after diagnosis. […] The limited data that are available show that, for most patients, inflammatory markers and abnormal echocardiogram findings will normalize within 4 weeks after hospitalization. […] Most signs and symptoms resolve by 6 months; signs and symptoms persisting at 6 months have included muscular fatigue, abnormalities on neurologic exam, anxiety, and emotional difficulties.

• #59 Clinical Treatment of Multisystem Inflammatory Syndrome in Children | MIS | CDC

  https://www.cdc.gov/mis/hcp/clinical-care-treatment/index.html

  Aspirin has commonly been used because of concerns for coronary artery involvement, and antibiotics are routinely used to treat potential sepsis while awaiting bacterial cultures. […] Evaluation and testing after hospitalization are based on the presentation and clinical course of each patient with MIS. […] Cardiology follow-up with repeat echocardiogram is generally recommended for patients with MIS cardiac manifestations. […] Follow-up with the patient’s primary care provider is important. A conversation between the patient, their guardian(s), and the clinical team or a specialist should occur to assist with decisions about COVID-19 vaccination after MIS. […] Most MIS-C patients have had good outcomes with no significant complications 1 year after diagnosis. […] The limited data that are available show that, for most patients, inflammatory markers and abnormal echocardiogram findings will normalize within 4 weeks after hospitalization. […] Most signs and symptoms resolve by 6 months; signs and symptoms persisting at 6 months have included muscular fatigue, abnormalities on neurologic exam, anxiety, and emotional difficulties.

• #60 MIS-C: A COVID-Related Complication Parents Need to Watch For | BAYADA

  https://blog.bayada.com/be-healthy/covid-related-misc

  The good news is that most children will recover from MIS-C. While some studies such as the one published in The Lancet Child Adolescent Health Journal (May 2021) noted that a small number of children who had severe MIS-C symptoms still had problems six months post-infection, long-term damage to organs is rare.

• #61 Multisystem Inflammatory Syndrome in Children (MIS-C)

  https://pmc.ncbi.nlm.nih.gov/articles/PMC8938222/

  The novel coronavirus disease 2019 (COVID-19) is caused by severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) and has developed into a pandemic. A unique challenge of this pandemic has been the emergence of multisystem inflammatory syndrome in children (MIS-C), a rare post-infectious hyperinflammatory disorder associated with SARS-CoV-2. This syndrome is characterized by overwhelming systemic inflammation, fever, hypotension, and cardiac dysfunction. This disorder may also have features overlapping with Kawasaki disease (KD), macrophage activation syndrome (MAS), and toxic shock syndrome (TSS). The goal of this review is to outline the presenting features, presumed immunopathogenesis, management, and outcomes of patients with MIS-C. […] Current treatment guidelines recommend intravenous immunoglobulins (IVIG) and glucocorticoids, with utilization of biologics in refractory cases. Fortunately, the majority of patients recover, with resolution of the systemic inflammation and cardiac abnormalities. Mortality from MIS-C is rare.

• #62 Multisystem inflammatory syndrome in children | NIH MedlinePlus Magazine

  https://magazine.medlineplus.gov/article/multisystem-inflammatory-syndrome-in-children

  If a child has any of these symptoms, they need emergency medical care right away: […] Although there have been cases in adults and teenagers, most people who get multisystem inflammatory syndrome are children between ages 1 and 15. […] The best way to keep children safe from MIS-C is to protect them from getting infected with the virus that causes COVID-19. […] Research studies at multiple sites across the country aim to answer important questions like: […] The Long-term Outcomes after the Multisystem Inflammatory Syndrome in Children (MUSIC) study is looking at how MIS-C affects childrens healthboth in the short term and over time. […] The study has a specific focus on health disparities (when certain groups of people have worse health outcomes than others) and aims to: […] Its goal is to develop innovative approaches to understanding the underlying factors that influence the spectrum of conditions that may occur in children infected with the COVID-19 virus. […] Visit ClinicalTrials.gov to find more clinical research studies about MIS-C.

• #63 About MIS | MIS | CDC

  https://www.cdc.gov/mis/about/index.html

  Multisystem inflammatory syndrome (MIS) can affect children (MIS-C) and adults (MIS-A). […] MIS is a rare but serious condition associated with SARS-CoV-2, the virus that causes COVID-19, in which different internal and external body parts become inflamed, including the heart, lungs, kidneys, brain, skin, eyes, and gastrointestinal tract. […] MIS can affect children (MIS-C) and adults (MIS-A). MIS-A is less common than MIS-C. Children with MIS-C appear to recover quickly from heart-related complications. […] Many children with MIS-C have had no or few symptoms of COVID-19. […] Most children with MIS-C do not have any reported underlying medical conditions. […] Of the children with MIS-C who do report an underlying medical condition, obesity is the most common. […] Based on what we know now, the best way to prevent MIS-C or MIS-A is to take actions to protect yourself from getting COVID-19, including COVID-19 vaccination for people 6 months and older.

• #64

  https://www.healthychildren.org/English/health-issues/conditions/COVID-19/Pages/covid_inflammatory_condition.aspx

  MIS-C can cause the wall of the heart to be inflamed (myocarditis). Patients with myocarditis will be restricted from activities like exercise or sports for a period of time. […] Yes, all children who are eligible should receive the recommended dose or doses of COVID vaccine. […] The best way to prevent MIS-C is for all eligible children age 6 months and up to get the updated COVID vaccine. […] While MIS-C sounds frightening, it is very rare.

• #65 Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19: What Do We Know? | EBSCO

  https://www.ebsco.com/blogs/health-notes/multisystem-inflammatory-syndrome-children-mis-c-associated-covid-19-what-do-we

  Children with MIS-C suffer from persistent fever and fatigue, visible inflammatory symptoms such as rash, oral mucosal changes and conjunctivitis, and gastrointestinal symptoms such as vomiting, diarrhea and abdominal pain. […] Treatment for MIS-C is based on best practice guidance for management of Kawasaki disease with the goal of reducing inflammation to protect vital organ function. […] The best protection from MIS-C is prevention of COVID-19, which for many remains physical distancing, wearing masks in public and respiratory hygiene including frequent hand washing for all members of a household.

• #66 Multisystem Inflammatory Syndrome in Children (MIS-C) – HAN

  https://www.chicagohan.org/covid-19/mis-c

  Multisystem inflammatory syndrome in children (MIS-C) is a rare but severe post-infectious sequela of COVID-19 in children marked by fever, elevated inflammatory markers, and severe illness involving two or more organ systems. […] COVID-19 vaccination is highly effective in preventing MIS-C, and all age-eligible children should be up-to-date with their vaccination. […] All health care providers should maintain a high index of suspicion for MIS-C. […] Suspected cases of MIS-C should be referred immediately to a tertiary care center with a pediatric intensive care unit (PICU). […] Tertiary care centers are asked to consider a collaborative approach in the management of these patients by convening a multispecialty committee (comprised of pediatric critical care, cardiology, hematology, infectious disease, and rheumatology/immunology) that provides coordinated clinical care guidance for each patient while (1) confirming patients meet the case definition, and (2) ensuring that appropriate diagnostic and treatment resources are readily available for this patient population.

• #67 What parents need to know about multisystem inflammatory syndrome in children (MIS-C) | Texas Children’s

  https://www.texaschildrens.org/content/wellness/what-parents-need-know-about-multisystem-inflammatory-syndrome-children-mis-c

  MIS-C has become more prevalent this fall due to the significant spread of the COVID-19 delta variant this summer, children returning back to school (and often unmasked), and lack of eligibility for the COVID vaccines in kids less than 12. […] The average age of kids impacted is 8 and 9 year olds; teenagers seem to have more severe cases but kids of any age may require ICU care for low blood pressure or heart dysfunction. […] MIS-C is a syndrome of the unvaccinated. Very few of our MIS-C cases have been fully vaccinated prior to exposure to the SARS-Cov-2 virus and development of MIS-C. […] Understandably, COVID-19 and MIS-C have created much anxiety among parents. […] First, I think it is important to make sure you follow all local and national expert recommendations regarding protecting our children from COVID.

• #68 Frontiers | Multisystem inflammatory syndrome in children (MIS-C) and “Near MIS-C”: A continuum?

  https://www.frontiersin.org/articles/10.3389/fped.2022.988706/full

  Multisystem inflammatory syndrome in children (MIS-C) presents a diagnostic challenge due to the nonspecific symptoms, lack of pathognomonic findings, and potentially fatal complications. […] MIS-C presents a diagnostic challenge for the physician due to the nonspecific early symptoms, lack of pathognomonic findings, and potentially fatal complications. […] Based on our experience, we favor the hypothesis that MIS-C has a continuum of severity that necessitates revisiting and unifying the current definitions. […] More research is needed to fully understand its pathogenesis, clinical presentation spectrum, and diagnostic criteria.

• #69 Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with COVID-19

  https://ceufast.com/course/multisystem-inflammatory-syndrome-in-children-mis-c-associated-with-covid-19

  Once patients have been stabilized and acute illness has passed, close follow-up is needed to track the return of inflammatory markers back to normal, monitor cardiac function and resolution of coronary artery dilation, and assess for any lasting organ dysfunction or damage. […] The current recommendation is for all children ages 6 months and older to receive an initial COVID-19 vaccine and at least 1 updated vaccine. […] Early identification of MIS-C is also an important nursing intervention. For children who are seen in the pediatric office with mild or even asymptomatic COVID-19, parents should be educated about signs and symptoms to be aware of in the coming weeks and when to seek further evaluation.

• #70 Multisystem Inflammatory Syndrome (MIS-C) in Children and COVID – What Nurses Should Know | Nurse.Org

  https://nurse.org/articles/mis-c-and-covid/

  Multisystem Inflammatory Syndrome (MIS-C) in Children and COVID – What Nurses Should Know […] MIS-C is a rare but severe hyperinflammatory condition in children and adolescents that typically occurs 26 weeks after a COVID-19 infection. […] Its important to educate patients and their families about the signs and symptoms of MIS-C. […] Currently, there is no single test to diagnose MIS-C. […] Much like there is no single test to diagnose MIS-C, there is no singular treatment for MIS-C. […] Due to the effect on multiple body systems, true healthcare collaboration is essential for treating patients with MIS-C. […] MIS-C remains a rare but possible deadly medical condition as a direct result of a COVID-19 infection despite the decreasing number of coronavirus infections.

• #71 COVID-19 and Multisystem Inflammatory Syndrome in Children (MIS-C) | FCEP

  https://fcep.org/covid-19-and-multisystem-inflammatory-syndrome-in-children-mis-c/

  Management of MIS-C patients depends on the severity of their presentation. Patients presenting with shock should be resuscitated per standard protocols, recognizing that many patients with shock in recent reports required inotropic support (47-80%) in addition to fluid resuscitation. […] Considering the multisystem effects, organizing a multi-disciplinary team to co-manage the patient is critical. […] MIS-C is a new entity and much remains to be determined regarding the pathophysiology, clinical findings, management and prognosis. Early recognition is critical as appropriate management with existing therapies does appear to result in good outcomes in many cases. The long-term prognosis of MIS-C is currently unknown.

• #72 Multi-inflammatory syndrome in children (MIS-C) associated with COVID-19: a nursing perspective experience report from a high-income tertiary paediatric hospital context | Pediatric Rheumatology | Full Text

  https://ped-rheum.biomedcentral.com/articles/10.1186/s12969-023-00786-y

  The large number of needle-related procedures in the care of these children was very difficult for the children and frustrating and challenging for the RNs. […] The RNs had a lot to think about regarding the complex drugs in care and they feared the risk of making mistakes. […] The results show that children suffering from MIS-C have many different areas of nursing focus, which challenges RNs and other professionals in paediatric hospital care. RNs, together with the interprofessional team, should pay attention to the quick changes in childrens health status. The care of children suffering from MIS-C demands resources and time from HCPs, especially RNs, to be able to meet the childrens needs and reduce their illbeing.

• #73

  https://www.nursingcenter.com/cearticle?an=00000446-202105000-00023&Journal_ID=54030&Issue_ID=5835877

  The American Academy of Pediatrics recommends outpatient pediatric cardiology follow-up beginning two to three weeks after discharge; those with MIS-C-associated myocarditis should have cardiology-directed guidance regarding physical activities. […] Nurses’ participation in the research will also ensure attention to the related nursing-sensitive outcome measures. […] Given that MIS-C patients may actively be shedding the COVID-19 virus, there is an urgent need for protocols regarding screening, triage, specific patient groups, and patient throughput, as well as for addressing surge. […] Surveillance data trends serve to alert communities and health care systems to surges in COVID-19 cases, which could result in more MIS-C cases.

• #74 Multisystem Inflammatory Syndrome: Symptoms & Causes | NewYork-Presbyterian

  https://www.nyp.org/pediatrics/rheumatology/multisystem-inflammatory-syndrome-mis-c

  Our pediatric rheumatology programs provide advanced, compassionate care to children with autoimmune, inflammatory, and rheumatic conditions and when critical care is needed, children benefit from the collaboration of our pediatric team with other specialty care teams. […] We know that a child’s illness can impact the entire family, and we are dedicated to providing complete care.

• #75 Multisystem Inflammatory Syndrome in Children (MIS-C) | IntechOpen

  https://www.intechopen.com/chapters/86668

  Treatment has two goals. The first is to stop hyperinflammation and the second is to treat cardiovascular complications that could be associated in severe cases. […] Many ways to immunomodulate the disease are described, most of them initially borrowed from Kawasaki disease and other hyperinflammatory syndromes. […] The use of biological therapy as rescue in patients refractory to IVIG/steroid treatment is described in many protocols. […] Severe MIS-C can lead to severe cardiovascular dysfunction that can be life threatening for children. […] MIS-C can be potentially life threatening. […] Recovery from acute organ dysfunctions occurs quickly with a median ICU length of stay of 5 days. […] Early recognition of the disease is fundamental through the signs and symptoms described, in order to perform a precocious immunomodulatory treatment that allows the control of the disease and better outcomes. […] In the post-COVID era, the effort must then focus on maintaining the clinical search for the disease, maintaining vaccination of both adults and children, and in prioritizing less developed countries with poor access to vaccination.

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