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Cardiac Decompensation Seen in Children Following COVID-19

Cardiac decompensation occurred in conjunction with multisystem inflammatory syndrome in some children

FRIDAY, May 22, 2020 (HealthDay News) -- Children may experience acute cardiac decompensation due to a severe inflammatory state (multisystem inflammatory syndrome in children or MIS-C) following infection with severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), according to a study published online May 17 in Circulation.

Zahra Belhadjer, M.D., from M3C-Necker Enfants Malades in Paris, and colleagues collected clinical, biological, therapeutic, and early outcomes data from 35 children who were admitted to the pediatric intensive care unit for cardiogenic shock, left ventricular dysfunction, and severe inflammatory status over a two-month period during the SARS-CoV-2 pandemic in France and Switzerland.

The children had a median age at admission of 10 years. The researchers found that 28 percent had comorbidities, including asthma and overweight. Gastrointestinal symptoms were prominently observed. In one-third of children, left ventricular ejection fraction was <30 percent, while 80 percent required inotropic support and 28 percent were treated with extracorporeal membrane oxygenation (ECMO). Inflammatory markers indicated cytokine storm (interleukin 6: median, 135 pg/mL) and macrophage activation (D-dimer: median, 5,284 ng/mL). There was elevation of mean brain natriuretic peptide (5,743 pg/mL). Eighty-eight percent of the patients tested positive for SARS-CoV-2 infection. All patients received intravenous immunoglobulin and one-third received adjunctive steroid therapy. In 25 of 35 patients discharged from the intensive care unit, left ventricular function was restored. No patients died and weaning from ECMO was successful.

"Early diagnosis and management appear to lead to favorable outcome using classical therapies," the authors write. They added, "Treatment with immune globulin appears to be associated with recovery of left ventricular systolic function."

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