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Paediatric Inflammatory Multisystem Syndrome: Temporally Associated with SARS-CoV-2 (PIMS-TS): Cardiac Features, Management and Short-Term Outcomes at a UK Tertiary Paediatric Hospital.
Pediatr Cardiol. 2020 Oct; 41(7):1391-1401.PC

Abstract

Children were relatively spared during COVID-19 pandemic. However, the recently reported hyperinflammatory syndrome with overlapping features of Kawasaki disease and toxic shock syndrome-"Paediatric Inflammatory Multisystem Syndrome-temporally associated with SARS-CoV-2" (PIMS-TS) has caused concern. We describe cardiac findings and short-term outcomes in children with PIMS-TS at a tertiary children's hospital. Single-center observational study of children with PIMS-TS from 10th April to 9th May 2020. Data on ECG and echocardiogram were retrospectively analyzed along with demographics, clinical features and blood parameters. Fifteen children with median age of 8.8 (IQR 6.4-11.2) years were included, all were from African/Afro-Caribbean, South Asian, Mixed or other minority ethnic groups. All showed raised inflammatory/cardiac markers (CRP, ferritin, Troponin I, CK and pro-BNP). Transient valve regurgitation was present in 10 patients (67%). Left Ventricular ejection fraction was reduced in 12 (80%), fractional shortening in 8 (53%) with resolution in all but 2. Fourteen (93%) had coronary artery abnormalities, with normalization in 6. ECG abnormalities were present in 9 (60%) which normalized in 6 by discharge. Ten (67%) needed inotropes and/or vasopressors. None needed extracorporeal life support. Improvement in cardiac biochemical markers was closely followed by improvement in ECG/echocardiogram. All patients were discharged alive and twelve (80%) have been reviewed since. Our entire cohort with PIMS-TS had cardiac involvement and this degree of involvement is significantly more than other published series and emphasizes the need for specialist cardiac review. We believe that our multi-disciplinary team approach was crucial for the good short-term outcomes.

Authors+Show Affiliations

Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK.Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK.Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK.Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK.Department of Paediatrics, Manor Hospital, Walsall, WS2 9PS, UK.Institute of Immunology and Immunotherapy, University of Birmingham, Birmingham, B15 2TT, UK.Department of Paediatrics, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, B4 6NH, UK.Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, B4 6NH, UK. Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT, UK.Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B9 5SS, UK.Department of Paediatrics, Birmingham Chest Clinic and Heartlands Hospital, University Hospitals Birmingham NHS Foundation Trust, Birmingham, B9 5SS, UK.Birmingham Clinical Trials Unit, University of Birmingham, Birmingham, B15 2TT, UK. Childhood Arthritis and Rheumatic Diseases Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, B4 6NH, UK.Paediatric Intensive Care Unit, Birmingham Women's and Children's NHS Foundation Trust, Birmingham, B4 6NH, UK. Birmingham Acute Care Research Group, Institute of Inflammation and Ageing, University of Birmingham, Birmingham, B15 2TT, UK.Department of Cardiology, Birmingham Women's and Children's NHS Foundation Trust, Steelhouse Lane, Birmingham, B4 6NH, UK. a.chikermane@nhs.net.

Pub Type(s)

Journal Article
Observational Study

Language

eng

PubMed ID

32529358

Citation

Ramcharan, Tristan, et al. "Paediatric Inflammatory Multisystem Syndrome: Temporally Associated With SARS-CoV-2 (PIMS-TS): Cardiac Features, Management and Short-Term Outcomes at a UK Tertiary Paediatric Hospital." Pediatric Cardiology, vol. 41, no. 7, 2020, pp. 1391-1401.
Ramcharan T, Nolan O, Lai CY, et al. Paediatric Inflammatory Multisystem Syndrome: Temporally Associated with SARS-CoV-2 (PIMS-TS): Cardiac Features, Management and Short-Term Outcomes at a UK Tertiary Paediatric Hospital. Pediatr Cardiol. 2020;41(7):1391-1401.
Ramcharan, T., Nolan, O., Lai, C. Y., Prabhu, N., Krishnamurthy, R., Richter, A. G., Jyothish, D., Kanthimathinathan, H. K., Welch, S. B., Hackett, S., Al-Abadi, E., Scholefield, B. R., & Chikermane, A. (2020). Paediatric Inflammatory Multisystem Syndrome: Temporally Associated with SARS-CoV-2 (PIMS-TS): Cardiac Features, Management and Short-Term Outcomes at a UK Tertiary Paediatric Hospital. Pediatric Cardiology, 41(7), 1391-1401. https://doi.org/10.1007/s00246-020-02391-2
Ramcharan T, et al. Paediatric Inflammatory Multisystem Syndrome: Temporally Associated With SARS-CoV-2 (PIMS-TS): Cardiac Features, Management and Short-Term Outcomes at a UK Tertiary Paediatric Hospital. Pediatr Cardiol. 2020;41(7):1391-1401. PubMed PMID: 32529358.
* Article titles in AMA citation format should be in sentence-case
TY - JOUR T1 - Paediatric Inflammatory Multisystem Syndrome: Temporally Associated with SARS-CoV-2 (PIMS-TS): Cardiac Features, Management and Short-Term Outcomes at a UK Tertiary Paediatric Hospital. AU - Ramcharan,Tristan, AU - Nolan,Oscar, AU - Lai,Chui Yi, AU - Prabhu,Nanda, AU - Krishnamurthy,Raghu, AU - Richter,Alex G, AU - Jyothish,Deepthi, AU - Kanthimathinathan,Hari Krishnan, AU - Welch,Steven B, AU - Hackett,Scott, AU - Al-Abadi,Eslam, AU - Scholefield,Barnaby R, AU - Chikermane,Ashish, Y1 - 2020/06/12/ PY - 2020/05/28/received PY - 2020/06/05/accepted PY - 2020/6/13/pubmed PY - 2020/10/22/medline PY - 2020/6/13/entrez KW - COVID-19 KW - Hyper-inflammatory KW - Kawasaki KW - MIS-C KW - PIMS-TS KW - SARS-CoV-2 SP - 1391 EP - 1401 JF - Pediatric cardiology JO - Pediatr Cardiol VL - 41 IS - 7 N2 - Children were relatively spared during COVID-19 pandemic. However, the recently reported hyperinflammatory syndrome with overlapping features of Kawasaki disease and toxic shock syndrome-"Paediatric Inflammatory Multisystem Syndrome-temporally associated with SARS-CoV-2" (PIMS-TS) has caused concern. We describe cardiac findings and short-term outcomes in children with PIMS-TS at a tertiary children's hospital. Single-center observational study of children with PIMS-TS from 10th April to 9th May 2020. Data on ECG and echocardiogram were retrospectively analyzed along with demographics, clinical features and blood parameters. Fifteen children with median age of 8.8 (IQR 6.4-11.2) years were included, all were from African/Afro-Caribbean, South Asian, Mixed or other minority ethnic groups. All showed raised inflammatory/cardiac markers (CRP, ferritin, Troponin I, CK and pro-BNP). Transient valve regurgitation was present in 10 patients (67%). Left Ventricular ejection fraction was reduced in 12 (80%), fractional shortening in 8 (53%) with resolution in all but 2. Fourteen (93%) had coronary artery abnormalities, with normalization in 6. ECG abnormalities were present in 9 (60%) which normalized in 6 by discharge. Ten (67%) needed inotropes and/or vasopressors. None needed extracorporeal life support. Improvement in cardiac biochemical markers was closely followed by improvement in ECG/echocardiogram. All patients were discharged alive and twelve (80%) have been reviewed since. Our entire cohort with PIMS-TS had cardiac involvement and this degree of involvement is significantly more than other published series and emphasizes the need for specialist cardiac review. We believe that our multi-disciplinary team approach was crucial for the good short-term outcomes. SN - 1432-1971 UR - https://www.unboundmedicine.com/medline/citation/32529358/Paediatric_Inflammatory_Multisystem_Syndrome:_Temporally_Associated_with_SARS_CoV_2__PIMS_TS_:_Cardiac_Features_Management_and_Short_Term_Outcomes_at_a_UK_Tertiary_Paediatric_Hospital_ L2 - https://dx.doi.org/10.1007/s00246-020-02391-2 DB - PRIME DP - Unbound Medicine ER -