Zahra Belhadjer1,2, Mathilde Méot1, Fanny Bajolle1, Diala Khraiche1, Antoine Legendre1, Samya Abakka1, Johanne Auriau1, Marion Grimaud1, Mehdi Oualha1, Maurice Beghetti3, Julie Wacker3, Caroline Ovaert4,5, Sebastien Hascoet6, Maëlle Selegny7, Sophie Malekzadeh-Milani1, Alice Maltret1, Gilles Bosser8, Nathan Giroux8, Laurent Bonnemains9, Jeanne Bordet9, Sylvie Di Filippo10, Pierre Mauran11, Sylvie Falcon-Eicher12, Jean-Benoît Thambo13, Bruno Lefort14, Pamela Moceri15, Lucile Houyel1,2, Sylvain Renolleau1,2, Damien Bonnet1,2. 1. M3C-Necker Enfants Malades, AP-HP, Paris, France (Z.B., M.M., F.B., D.K., A.L., S.A., J.A., M.G., M.O., S.M.-M., A.M., L.H., S.R., D.B.). 2. Université de Paris, France (Z.B., L.H., S.R., D.B.). 3. Pediatric Cardiology Unit, University Hospital, Geneva, Switzerland (M.B., J.W.). 4. Paediatric and Congenital Cardiology Department, M3C Regional CHD Center, La Timone University Hospital, Marseille, France (C.O.). 5. INSERM UMR 1251, Marseille Medical Genetics, University of Aix-Marseille, Marseille, France (C.O.). 6. M3C Marie-Lannelongue Hospital, Paediatric and Congenital Cardiac Surgery Department, Groupe Hospitalier Saint-Joseph, Paris Sud University, Plessis-Robinson, France (S.H.). 7. Pediatric-Cardiology, Amiens-Picardie University Hospital, Amiens, France (M.S.). 8. CHRU de Nancy, Service de cardiologie congénitale et pédiatrique, Vandoeuvre-lès-Nancy, France (G.B., N..G.). 9. Department of Cardiac Surgery, University of Strasbourg, France (L.B., J.B.). 10. Pediatric Cardiology and Congenital Heart Disease Department, Cardiovascular Louis-Pradel Hospital, Hospices Civils de Lyon, France (S.D.F.). 11. Department of Paediatric and Congenital Cardiology, Center de compétence M3C, American Memorial Hospital, CHU de Reims, France (P. Mauran). 12. CHU Dijon-Bourgogne, Dijon, France (S.F.-E.). 13. CHU Bordeaux, Department of Pediatric Cardiology, Bordeaux-II University, France (J.-B.T.). 14. Unité de Cardiologie Pédiatrique, Hôpital des Enfants Gatien de Clocheville, INSERM UMR 1069 et Université François Rabelais, Tours, France (B.L.). 15. Department of Cardiology, Hôpital Pasteur, CHU de Nice, France (P. Moceri).
Abstract
BACKGROUND: Cardiac injury and myocarditis have been described in adults with coronavirus disease 2019 (COVID-19). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children is typically minimally symptomatic. We report a series of febrile pediatric patients with acute heart failure potentially associated with SARS-CoV-2 infection and the multisystem inflammatory syndrome in children as defined by the US Centers for Disease Control and Prevention. METHODS: Over a 2-month period, contemporary with the SARS-CoV-2 pandemic in France and Switzerland, we retrospectively collected clinical, biological, therapeutic, and early outcomes data in children who were admitted to pediatric intensive care units in 14 centers for cardiogenic shock, left ventricular dysfunction, and severe inflammatory state. RESULTS: Thirty-five children were identified and included in the study. Median age at admission was 10 years (range, 2-16 years). Comorbidities were present in 28%, including asthma and overweight. Gastrointestinal symptoms were prominent. Left ventricular ejection fraction was <30% in one-third; 80% required inotropic support with 28% treated with extracorporeal membrane oxygenation. Inflammation markers were suggestive of cytokine storm (interleukin-6 median, 135 pg/mL) and macrophage activation (D-dimer median, 5284 ng/mL). Mean BNP (B-type natriuretic peptide) was elevated (5743 pg/mL). Thirty-one of 35 patients (88%) tested positive for SARS-CoV-2 infection by polymerase chain reaction of nasopharyngeal swab or serology. All patients received intravenous immunoglobulin, with adjunctive steroid therapy used in one-third. Left ventricular function was restored in the 25 of 35 of those discharged from the intensive care unit. No patient died, and all patients treated with extracorporeal membrane oxygenation were successfully weaned. CONCLUSIONS: Children may experience an acute cardiac decompensation caused by severe inflammatory state after SARS-CoV-2 infection (multisystem inflammatory syndrome in children). Treatment with immunoglobulin appears to be associated with recovery of left ventricular systolic function.
BACKGROUND:Cardiac injury and myocarditis have been described in adults with coronavirus disease 2019 (COVID-19). Severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection in children is typically minimally symptomatic. We report a series of febrile pediatric patients with acute heart failure potentially associated with SARS-CoV-2 infection and the multisystem inflammatory syndrome in children as defined by the US Centers for Disease Control and Prevention. METHODS: Over a 2-month period, contemporary with the SARS-CoV-2 pandemic in France and Switzerland, we retrospectively collected clinical, biological, therapeutic, and early outcomes data in children who were admitted to pediatric intensive care units in 14 centers for cardiogenic shock, left ventricular dysfunction, and severe inflammatory state. RESULTS: Thirty-five children were identified and included in the study. Median age at admission was 10 years (range, 2-16 years). Comorbidities were present in 28%, including asthma and overweight. Gastrointestinal symptoms were prominent. Left ventricular ejection fraction was <30% in one-third; 80% required inotropic support with 28% treated with extracorporeal membrane oxygenation. Inflammation markers were suggestive of cytokine storm (interleukin-6 median, 135 pg/mL) and macrophage activation (D-dimer median, 5284 ng/mL). Mean BNP (B-type natriuretic peptide) was elevated (5743 pg/mL). Thirty-one of 35 patients (88%) tested positive for SARS-CoV-2 infection by polymerase chain reaction of nasopharyngeal swab or serology. All patients received intravenous immunoglobulin, with adjunctive steroid therapy used in one-third. Left ventricular function was restored in the 25 of 35 of those discharged from the intensive care unit. No patient died, and all patients treated with extracorporeal membrane oxygenation were successfully weaned. CONCLUSIONS:Children may experience an acute cardiac decompensation caused by severe inflammatory state after SARS-CoV-2 infection (multisystem inflammatory syndrome in children). Treatment with immunoglobulin appears to be associated with recovery of left ventricular systolic function.
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