Abstract
Pediatric inflammatory multisystem syndrome temporally associated with severe acute
respiratory syndrome coronavirus 2 (SARS-CoV-2; PIMS-TS) is a novel condition with
persistent fever, inflammation, and single or multiorgan dysfunction. We aimed to
describe the characteristics of children more severely affected and our clinical approach.
We retrospectively collected clinical, treatment, and early outcomes data during a
3-month period in a pediatric intensive care unit (PICU) of a tertiary university
hospital in Portugal. Twelve children who fulfilled the Royal College of Pediatrics
and Child Health case definition were hospitalized, seven needed PICU admission. Median
age was 13 years and three were overweight, with no other comorbidity. All had positive
immunoglobulin G antibodies for SARS-CoV-2. All presented with prolonged fever, asthenia,
hypotension, and shock. Other prominent symptoms were abdominal complaints and rash.
All patients had leukocytosis, neutrophilia, and marked elevation of inflammatory
markers. Cardiac involvement was observed in all patients with elevated levels of
troponin and B-type natriuretic peptide along with left ventricular hypokinesis. Depressed
left ventricular function was observed in four patients. All patients received broad-spectrum
antibiotics, intravenous immunoglobulin, methylprednisolone, low-dose aspirin, and
vasoactive medications. Four patients received prophylactic enoxaparin. All patients
needed supplementary oxygen; however, high-flow oxygen therapy and noninvasive ventilatory
support with positive end-expiratory pressure were required in three and two patients,
respectively. Five patients required invasive mechanical ventilation. The mean duration
of PICU stay was 7.1 days. The median Pediatric Risk of Mortality-III score was 9
and no mortality was observed. PIMS-TS demands a prompt and multidisciplinary approach.
Risk factors, best clinical pathway, and long-term complications are still unknown.
Keywords
SARS-CoV-2 - COVID-19 - care - shock - PIMS-TS
