Multisystem inflammatory syndrome in children (MIS-C) and neonates (MIS-N) associated with COVID-19: optimizing definition and management.

Autor: Molloy EJ; Discipline of Paediatrics, Trinity College Dublin, the University of Dublin, Trinity Research in Childhood Centre (TRICC) and Trinity Translational Medicine Institute (TTMI), Trinity College Dublin, Dublin, Ireland. Eleanor.molloy@tcd.ie.; Children's Hospital Ireland (CHI) at Tallaght, Dublin and Neonatology, CHI at Crumlin, Dublin, Ireland. Eleanor.molloy@tcd.ie.; Neonatology, Coombe Women's and Infants University Hospital, Dublin, Ireland. Eleanor.molloy@tcd.ie., Nakra N; Division of Infectious Diseases, Department of Pediatrics, UC Davis Children's Hospital, Sacramento, CA, USA., Gale C; Neonatal Medicine, School of Public Health, Faculty of Medicine, Imperial College London, Chelsea and Westminster Hospital Campus, London, UK., Dimitriades VR; Division of Allergy, Immunology and Rheumatology, Department of Pediatrics, UC Davis Children's Hospital, Sacramento, CA, USA., Lakshminrusimha S; Division of Neonatology, Department of Pediatrics, UC Davis Children's Hospital, Sacramento, CA, USA.
Jazyk: angličtina
Zdroj: Pediatric research [Pediatr Res] 2023 May; Vol. 93 (6), pp. 1499-1508. Date of Electronic Publication: 2022 Sep 01.
DOI: 10.1038/s41390-022-02263-w
Abstrakt: During the SARS-CoV-2-associated infection (COVID-19), pandemic initial reports suggested relative sparing of children inversely related to their age. Children and neonates have a decreased incidence of SARS-CoV-2 infection, and if infected they manifested a less severe phenotype, in part due to enhanced innate immune response. However, a multisystem inflammatory syndrome in children (MIS-C) or paediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 emerged involving coronary artery aneurysms, cardiac dysfunction, and multiorgan inflammatory manifestations. MIS-C has many similarities to Kawasaki disease and other inflammatory conditions and may fit within a spectrum of inflammatory conditions based on immunological results. More recently neonates born to mothers with SARS-CoV-2 infection during pregnancy demonstrated evidence of a multisystem inflammatory syndrome with raised inflammatory markers and multiorgan, especially cardiac dysfunction that has been described as multisystem inflammatory syndrome in neonates (MIS-N). However, there is a variation in definitions and management algorithms for MIS-C and MIS-N. Further understanding of baseline immunological responses to allow stratification of patient groups and accurate diagnosis will aid prognostication, and inform optimal immunomodulatory therapies. IMPACT: Multisystem inflammatory system in children and neonates (MIS-C and MIS-N) post COVID require an internationally recognized consensus definition and international datasets to improve management and plan future clinical trials. This review incorporates the latest review of pathophysiology, clinical information, and management of MIS-C and MIS-N. Further understanding of the pathophysiology of MIS-C and MIS-N will allow future targeted therapies to prevent and limit clinical sequelae.
(© 2022. The Author(s).)
Databáze: MEDLINE
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