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Cardiac implications of multisystem inflammatory syndrome associated with COVID-19 in children under the age of 5 years

Part of: Covid-19 Echocardiography

Published online by Cambridge University Press:  15 July 2021

Shaimaa Rakha Open the ORCID record for Shaimaa Rakha [Opens in a new window] ,
Ali Sobh ,
Amira H. Hager ,
Mona Hafez ,
Gehan A. Alsawah ,
Mohamed Magdi Abuelkheir ,
Mayada Sabry Zeid ,
Mohamed Nahas  and
Hala Elmarsafawy Open the ORCID record for Hala Elmarsafawy [Opens in a new window]
Shaimaa Rakha*
Affiliation:
Pediatric Cardiology Unit, Pediatrics Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Ali Sobh
Affiliation:
Pediatric Infections and Immunology Unit, Pediatrics department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Amira H. Hager
Affiliation:
Pediatric Cardiology Unit, Pediatrics Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Mona Hafez
Affiliation:
Pediatric Cardiology Unit, Pediatrics Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Gehan A. Alsawah
Affiliation:
Pediatric Cardiology Unit, Pediatrics Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Mohamed Magdi Abuelkheir
Affiliation:
Pediatric Cardiology Unit, Pediatrics Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Mayada Sabry Zeid
Affiliation:
Pediatric Infections and Immunology Unit, Pediatrics department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Mohamed Nahas
Affiliation:
Clinical Pathology Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
Hala Elmarsafawy
Affiliation:
Pediatric Cardiology Unit, Pediatrics Department, Faculty of Medicine, Mansoura University, Mansoura, Egypt
*
Author for correspondence: Shaimaa Rakha, MD, MRCPCH, Pediatric Cardiology Unit, Mansoura University Children Hospital, El Gomhouria St, Mansoura, Dakahlia Governorate 35516, Egypt. Tel: +201030077567. Email: drshimaarhaka@mans.edu.eg
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Abstract

Background:

Coronavirus disease 2019 (COVID-19) is responsible for significant lung disease in adults. Despite mild manifestations in most children, multisystem inflammatory syndrome (MIS-C) associated with COVID-19 is well described in older children with cardiac manifestations. However, MIS-C-related cardiac manifestations are not as well described in younger children.

Methods:

The study is a retrospective analysis of MIS-C patients under the age of 5 years admitted between May and November 2020 to a single centre. Included cases fulfilled the case definition of MIS-C according to Royal College of Pediatrics and Child Health criteria with laboratory, electrocardiogram, or echocardiographic evidence of cardiac disease. Collected data included patients’ demographics, laboratory results, echocardiographic findings, management, and outcomes.

Results:

Out of 16 MIS-C cases under 5 years of age, 10 (62.5%) had cardiac manifestations with a median age of 12 months, 9 (90%) were previously healthy. Cardiac manifestations included coronary arterial aneurysms or ectasia in five (50%) cases, two (20%) with isolated myopericarditis, coronary ectasia with myocarditis in two (20%), and supraventricular tachycardia in one (10%). Intravenous immunoglobulins were given in all cases with coronary involvement or myocarditis. The median duration of hospitalisation was 7 (6–14) days; two (20%) cases with cardiac disease were mechanically ventilated and mortality in MIS-C cases below 5 years was 12.5%. Normalisation of systolic function occurred in half of the affected cases within 1 week and reached 100% by 30 days of follow-up.

Conclusions:

MIS-C associated with SARS-CoV-2 has a high possibility of serious associated cardiac manifestations in children under the age of 5 years with mortality and/or long-term morbidities such as coronary aneurysms even in previously healthy children.

Keywords

Cardiacmultisystem inflammatory syndromeCOVID-19under 5 years
Type
Original Article
Information
Cardiology in the Young , Volume 32 , Issue 5 , May 2022 , pp. 800 - 805
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Copyright
© The Author(s), 2021. Published by Cambridge University Press

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Footnotes

Shaimaa Rakha and Ali Sobh are equal first authors.

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