Immunotherapy, steroids had positive outcomes in children with COVID-related multi-system inflammatory syndrome

May 19, 2020

DALLAS, May 18, 2020 -- Treatment with antibodies purified from donated blood - immune globulin therapy - and steroids restored heart function in the majority of children with COVID-related multi-system inflammatory syndrome, according to new research published yesterday in Circulation, the flagship journal of the American Heart Association.

Physicians around the world have recently noted that a small number of children exposed to COVID-19 have an emerging condition with features overlapping toxic shock syndrome and similar to a heart condition known as Kawasaki disease, together with cardiac inflammation. The symptoms most commonly observed are high-spiking fever, unusual lethargy over several days (asthenia), digestive signs including severe abdominal pain, vomiting or diarrhea, swollen lymph nodes (adenopathy) and skin rash.

In this small study, "Acute heart failure in multisymptom inflammatory syndrome in children (MIS0-C) in the context of global SARS-CoV-2 pandemic," researchers in France and Switzerland retrospectively collected and analyzed clinical, biological, therapeutic and early outcome data for children admitted to the pediatric intensive care unit from March 22 to April 30, 2020, with fever, cardiogenic shock or acute left ventricular dysfunction with inflammatory state.

This analysis included 35 children (ages 2 to 16; median age of 10 years). Thirty-one (88.5%) children tested positive for SARS-CoV-2 infection, and none of the children had underlying cardiovascular disease. Secondary conditions were limited, and 17% of patients were overweight (n=6). All patients presented with fever and unusual lethargy (asthenia) lasting approximately 2 days, and 83% of patients (n=29) presented with gastrointestinal symptoms.

Left ventricular systolic dysfunction was present in all patients in association with low systolic blood pressure. Almost all patients required respiratory assistance (n= 33). Left ventricular function recovered in the majority of patients discharged from the intensive care unit (n=25). Ten patients treated with ECMO (extracorporeal membrane oxygenation) for 3-6 days were successfully weaned. (ECMO is a process whereby the blood is sent through a machine to increase the amount of oxygen in the blood. The oxygen-rich blood is then returned to the body.)

The majority of patients received intravenous immune globulin treatment (n=25), and 12 patients were treated with intravenous steroids. Three children were treated with an interleukin 1 receptor antagonist due to persistent severe inflammatory state. 23 patients were treated with a therapeutic dose of heparin. No deaths were observed.

"The majority of patients recovered within a few days following intravenous immune globulin, with adjunctive steroid therapy used in one third. Treatment with immune globulin appears to be associated with recovery of left ventricular systolic function," researchers reported.

The researchers' key findings are:
-end-
Authors are Zahra Belhadjer, M.D.; Mathilde Méot, M.D.; Fanny Bajolle, M.D., Ph.D.; Diala Khraiche, M.D.; Antoine Legendre, M.D.; Samya Abakka, M.D.; Johanne Auriau, M.D., Ph.D.; Marion Grimaud, M.D.; Mehdi Oualha, M.D., Ph.D.; Maurice Beghetti, M.D., Ph.D.; Julie Wacker, M.D.; Caroline Ovaert, M.D., Ph.D.; Sebastien Hascoet, M.D.; Maëlle Selegny, M.D.; Sophie Malekzadeh-Milani, M.D.; Alice Maltret, M.D.; Gilles Bosser, M.D., Ph.D.; Nathan Giroux, M.D.; Laurent Bonnemains, M.D., Ph.D.; Jeanne Bordet, M.D., Ph.D.; Sylvie Di Filippo, M.D., Ph.D.; Pierre Mauran, M.D., Ph.D; Sylvie Falcon-Eicher, M.D.; Jean-Benoît Thambo, M.D., Ph.D.; Bruno Lefort, M.D., Ph.D.; Pamela Moceri, M.D., Ph.D.; Lucile Houyel, M.D., Ph.D.; Sylvain Renolleau, M.D., Ph.D.; and Damien Bonnet, M.D., Ph.D. The authors have no disclosures.

Additional Resources:

Available multimedia is on right column of release link - https://newsroom.heart.org/news/immunotherapy-steroids-had-positive-outcomes-in-children-with-covid-related-multi-system-inflammatory-syndrome?preview=9b45ebe1c41631a609e03de94ce2b1b6

Statements and conclusions of study authors published in American Heart Association scientific journals are solely those of the study authors and do not necessarily reflect the Association's policy or position. The Association makes no representation or guarantee as to their accuracy or reliability. The Association receives funding primarily from individuals; foundations and corporations (including pharmaceutical, device manufacturers and other companies) also make donations and fund specific Association programs and events. The Association has strict policies to prevent these relationships from influencing the science content. Revenues from pharmaceutical and device corporations and health insurance providers are available at https://www.heart.org/en/about-us/aha-financial-information.

About the American Heart Association

The American Heart Association is a relentless force for a world of longer, healthier lives. We are dedicated to ensuring equitable health in all communities. Through collaboration with numerous organizations, and powered by millions of volunteers, we fund innovative research, advocate for the public's health and share lifesaving resources. The Dallas-based organization has been a leading source of health information for nearly a century. Connect with us on heart.org, Facebook, Twitter or by calling 1-800-AHA-USA1.

American Heart Association

Related Kawasaki Disease Articles from Brightsurf:

Children with Kawasaki Disease at higher risk for heart problems 10 years later
New research shows that children with Kawasaki Disease remain at an increased risk for cardiovascular events more than 10 years after hospitalization for their condition, highlighting the need for long-term heart disease surveillance and risk reduction strategies for these young patients.

Mechanism linking gum disease to heart disease, other inflammatory conditions discovered
The link between periodontal (gum) disease and other inflammatory conditions such as heart disease and diabetes has long been established, but the mechanism behind that association has, until now, remained a mystery.

Kawasaki disease is not a homogenous disease nor are its triggers
Researchers at UC San Diego report that while Kawasaki disease occurs in clusters, the traits, and thus the triggers of the inflammatory disease vary among clusters.

Combo therapy may prevent blood vessel complications in children with Kawasaki disease
For children with Kawasaki disease with higher risk of developing blood vessel complications, adding corticosteroids to standard intravenous immunoglobulin treatment could boost initial treatment response and prevent complications.

Potential link for Alzheimer's disease and common brain disease that mimics its symptoms
A new study by investigators from Brigham and Women's Hospital uncovered a group of closely related genes that may capture molecular links between Alzheimer's disease and Limbic-predominant Age-related TDP-43 Encephalopathy, or LATE, a recently recognized common brain disorder that can mimic Alzheimer's symptoms.

Antioxidant agent may prevent chronic kidney disease and Parkinson's disease
Researchers from Osaka University developed a novel dietary silicon-based antioxidant agent with renoprotective and neuroprotective effects.

Kawasaki-like syndrome linked to COVID-19 in children is a new condition
A study on children suffering from severe inflammatory symptoms shows the condition is new and distinct from Kawasaki disease.

Tools used to study human disease reveal coral disease risk factors
In a study published in Scientific Reports, a team of international researchers led by University of Hawai'i (UH) at Mānoa postdoctoral fellow Jamie Caldwell used a statistical technique typically employed in human epidemiology to determine the ecological risk factors affecting the prevalence of two coral diseases--growth anomalies, abnormalities like coral tumors, and white syndromes, infectious diseases similar to flesh eating bacteria.

Disease-aggravating mutation found in a mouse model of neonatal mitochondrial disease
The new mitochondrial DNA (mtDNA) variant drastically speeds up the disease progression in a mouse model of GRACILE syndrome.

Long-dormant disease becomes most dominant foliar disease in New York onion crops
Until recently, Stemphylium leaf blight has been considered a minor foliar disease as it has not done much damage in New York since the early 1990s.

Read More: Kawasaki Disease News and Kawasaki Disease Current Events
Brightsurf.com is a participant in the Amazon Services LLC Associates Program, an affiliate advertising program designed to provide a means for sites to earn advertising fees by advertising and linking to Amazon.com.