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The American Academy of Pediatrics (AAP) has released interim guidance for multisystem inflammatory syndrome in children (MIS-C).
In the early days of COVID-19, it seemed like the disease rarely infected children and when it did the disease course was mild. Then in late April, pediatricians in the United Kingdom and New York were discovering children who seemed to have something similar to Kawasaki disease (KD) and testing positive for COVID-19. The complication, multisystem inflammatory syndrome in children (MIS-C), remains the biggest wrinkle in pediatric cases of COVID-19. The American Academy of Pediatrics has released interim guidance for identifying and treating MIS-C.1
The guidance covered the symptoms that are common for the presentation of MIS-C:
If a clinician believes that a child has MIS-C, the testing may include an echocardiogram, an electrocardiogram, or a chest radiograph. Expanded testing such as troponin, pro-BNP, triglycerides, creatine kinase, amylase, blood and urine culture, D-dimer, prothrombin time/partial thromboplastin time, international normalized ratio, c-reactive protein, ferritin, lactic acid dehydrogenase, comprehensive metabolic panel, and fibrinogen should be ordered, if they haven’t been performed. The patient should also be tested for COVID-19.
The interim guidance included information for treating MIS-C:
The guidance highlighted the fact that many of the children diagnosed with MIS-C may have been prescribed antibiotics due to the need to start treatment in multiple avenues as soon as possible. It also mentions that children who are given steroids and biologics are often give a 3-week supply to taper off the steroid and/or biologic treatment.
1. American Academy of Pediatrics. Multisystem Inflammatory Syndrome in Children (MIS-C) Interim Guidance. Services.aap.org. Updated July 13, 2020. Accessed July 20, 2020. https://services.aap.org/en/pages/2019-novel-coronavirus-covid-19-infections/clinical-guidance/multisystem-inflammatory-syndrome-in-children-mis-c-interim-guidance/.