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    Correspondence: Acute Myocardial Injury: A Novel Clinical Pattern in Children With COVID-19

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    kayegi8666
    This document describes a case series of 5 children with COVID-19 who presented with cardiac injury and mild to moderate cardiac dysfunction. All 5 children had fever and gastrointestinal symptoms initially and 3 had a transient rash. On admission to the pediatric intensive care unit, they displayed tachycardia and hypotension. While in the PICU, they required intravenous medications including epinephrine to support their heart function. The children did not meet full criteria for Kawasaki disease but showed features resembling atypical Kawasaki disease or multisystem inflammatory syndrome related to COVID-19. This case series highlights the need to monitor children with COVID-19 for potential cardiac involvement.

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    Correspondence: Acute Myocardial Injury: A Novel Clinical Pattern in Children With COVID-19

    Uploaded by

    kayegi8666
    49 views2 pages
    This document describes a case series of 5 children with COVID-19 who presented with cardiac injury and mild to moderate cardiac dysfunction. All 5 children had fever and gastrointestinal symptoms initially and 3 had a transient rash. On admission to the pediatric intensive care unit, they displayed tachycardia and hypotension. While in the PICU, they required intravenous medications including epinephrine to support their heart function. The children did not meet full criteria for Kawasaki disease but showed features resembling atypical Kawasaki disease or multisystem inflammatory syndrome related to COVID-19. This case series highlights the need to monitor children with COVID-19 for potential cardiac involvement.

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    PIIS2352464220301681

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    This document describes a case series of 5 children with COVID-19 who presented with cardiac injury and mild to moderate cardiac dysfunction. All 5 children had fever and gastrointestinal symptoms initially and 3 had a transient rash. On admission to the pediatric intensive care unit, they displayed tachycardia and hypotension. While in the PICU, they required intravenous medications including epinephrine to support their heart function. The children did not meet full criteria for Kawasaki disease but showed features resembling atypical Kawasaki disease or multisystem inflammatory syndrome related to COVID-19. This case series highlights the need to monitor children with COVID-19 for potential cardiac involvement.

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    © All Rights Reserved
    Download as PDF, TXT or read online from Scribd
    Download as pdf or txt
    49 views2 pages

    Correspondence: Acute Myocardial Injury: A Novel Clinical Pattern in Children With COVID-19

    Uploaded by

    kayegi8666
    This document describes a case series of 5 children with COVID-19 who presented with cardiac injury and mild to moderate cardiac dysfunction. All 5 children had fever and gastrointestinal symptoms initially and 3 had a transient rash. On admission to the pediatric intensive care unit, they displayed tachycardia and hypotension. While in the PICU, they required intravenous medications including epinephrine to support their heart function. The children did not meet full criteria for Kawasaki disease but showed features resembling atypical Kawasaki disease or multisystem inflammatory syndrome related to COVID-19. This case series highlights the need to monitor children with COVID-19 for potential cardiac involvement.

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    Correspondence

    Acute myocardial injury: revealed elevated cardiac enzymes seven of eight children in the UK,4
    and inflammation markers. Complete six of ten children in the previous case
    a novel clinical pattern demographic, clinical findings, and series from Italy,5 and all five children Lancet Child Adolesc Health 2020
    in children with blood test results are shown in the in our case series had diarrhoea with or Published Online

    COVID-19 appendix. All children had a mild without vomiting and abdominal pain. June 1, 2020
    https://doi.org/10.1016/
    to moderate heart dysfunction Unexpectedly, the substantial increase S2352-4642(20)30168-1
    Reports of coronavirus disease 2019 highlighted by reduced ejection in cardiac enzymes (mainly NT-proBNP, See Online for appendix
    (COVID-19) show that children usually fraction (mean 47·8%, SD 9·1), and which increased to up to 30 times the
    have mild clinical signs and less severe all except patient 4 required a short normal value) was not associated with
    disease than do adults,1 although the course of intravenous epinephrine severe heart failure.
    reasons for such differences are not yet (dose range 0·05–0·1 µg/kg per min), Our case series reinforces the
    completely understood.2 A previous which in patient 2 was administered message that children with COVID-19
    report3 describing paediatric COVID-19 with intravenous PDE3 inhibitor should be closely monitored to
    cases in China showed that 13 (0·6%) (milrinone 0·25 µg/kg per min). recognise cardiac involvement and to
    of 2135 laboratory-confirmed and Four children had a midbasal prevent a severe and critical course of
    suspected cases were critical, but hypokinesis of the inferoseptal illness.
    myocardial involvement was not wall and inferior wall. The electro­ AW, SM, GZ, AC, and VG had full access to all the
    noted. At the time of writing, two cardiogram was abnormal with data in the study and take responsibility for the
    integrity and the accuracy of the data analysis.
    clinical scenarios of severe paediatric non-specific changes such as sinus All authors contributed equally in writing the paper,
    COVID-19 cases have been reported tachycardia, and ST and T-wave approved the final manuscript as submitted, and
    from the UK and Italy: severe shock abnormalities. Patient 2 developed agree to be accountable for all aspects of the work.
    We declare no competing interests. Verbal consent
    syndrome with hyperinflammation4 atrial fibrillation and had reversible
    was obtained from caregivers of all five patients.
    and Kawasaki-like-disease.5 acute kidney injury. Mean length of
    During March 15 to April 25, PICU stay was 3·4 days (range 1–5). All *Andrea Wolfler, Savina Mannarino,
    2020, nine patients were admitted children were discharged to the ward Vania Giacomet, Anna Camporesi,
    to our paediatric intensive care with a normal cardiac function and Gianvincenzo Zuccotti
    unit (PICU) for COVID-19; PCR tests good clinical conditions. Mean length wolfler69@gmail.com
    of nasopharyngeal samples for of hospital stay was 7·2 days (range Division of Anesthesia and Intensive Care (AW, AC),
    Division of Cardiology (SM), Department of
    severe acute respiratory syndrome 5–10). Pediatrics (VG, GZ), Children’s Hospital V Buzzi,
    coronavirus 2 were positive for all nine Increasing evidence shows that ASST FBF Sacco, Milan, Italy
    patients. Five of these patients had COVID-19 in children has different 1 Ludvigsson JF. Systematic review of COVID-19
    cardiac injury and mild to moderate clinical patterns. Our patients did not in children shows milder cases and a better
    prognosis than adults. Acta Paediatr 2020;
    cardiac dysfunction; we describe meet all the clinical criteria for classic or 109: 1088–95.
    these patients in this case series. All incomplete Kawasaki disease because 2 Brodin P. Why is COVID-19 so mild in
    five children (mean age 84·4 months, they had only one or two of the five children? Acta Paediatr 2020; 109: 1082–83.
    3 Dong Y, Mo X, Hu Y, et al. Epidemiology of
    range 2–168) were previously healthy criteria required. It is possible that this COVID-19 among children in China. Pediatrics
    and had fever and gastrointestinal clinical picture is the mild form of the 2020; published online March 16. https://doi.
    org/10.1542/peds.2020-0702.
    symptoms as initial signs at home. COVID-19-related shock described in
    4 Riphagen S, Gomez X, Gonzalez-Martinez C,
    Three patients (1, 4, and 5) had the UK, which is now being labelled as Wilkinson N, Theocharis P. Hyperinflammatory
    fleeting polymorphic rash; in paediatric multisystem inflammatory shock in children during COVID-19 pandemic.
    Lancet 2020; 395: 1607–08.
    patient 5, the rash was associated with syndrome.6 In both cases, a hyper­ 5 Verdoni L, Mazza A, Gervasoni A, et al.
    non-exudative conjunctivitis without inflammatory state is described with An outbreak of severe Kawasaki-like disease at
    involvement of the oral mucosa. Only cardiac involvement mimicking the Italian epicentre of the SARS-CoV-2
    epidemic: an observational cohort study.
    patient 2 had respiratory distress atypical Kawasaki disease. COVID-19 Lancet 2020; published online May 13.
    at home requiring non-invasive provokes a cytokine storm;7 in adults https://doi.org/10.1016/S0140-
    6736(20)31103-X.
    mechanical support during PICU stay; it mainly compromises the lung with 6 WHO. Multisystem inflammatory syndrome in
    none developed paediatric acute acute respiratory distress syndrome and children and adolescents temporally related to
    respiratory distress syndrome. On affects other organs such as the heart8,9 COVID-19. 2020. www.who.int/news-room/
    commentaries/detail/multisystem-
    PICU admission, the main clinical signs to a lesser extent, which condition a inflammatory-syndrome-in-children-and-
    were tachycardia and hypotension. higher mortality, whereas in children adolescent-with-covid-19 (accessed
    May 16, 2020).
    Patient 1 was oligoanuric and patients it seems to have a different target 7 Mehta P, McAuley DF, Brown M, et al;
    1, 3, and 5 had mild desaturation in with a prevalent cardiac involvement. COVID-19: consider cytokine storm syndromes
    spontaneous breathing in room air Interestingly, gastrointestinal symp­ and immunosuppression. Lancet 2020;
    395: 1033–34.
    (SpO2 94–96%). Blood examinations toms occurred in all three groups:

    www.thelancet.com/child-adolescent Published online June 1, 2020 https://doi.org/10.1016/S2352-4642(20)30168-1 1


    Correspondence

    8 Shi S, Qin M, Shen B, et al. Association of


    cardiac injury with mortality in hospitalized
    patients with COVID-19 in Wuhan, China.
    JAMA Cardiol 2020; published online March 25.
    DOI:10.1001/jamacardio.2020.0950.
    9  Guo T, Fan Y, Chen M, et al. Cardiovascular
    implications of fatal outcomes of patients with
    coronavirus disease 2019 (COVID-19).
    JAMA Cardiol 2020; published online March 27.
    DOI:10.1001/jamacardio.2020.1017.

    2 www.thelancet.com/child-adolescent Published online June 1, 2020 https://doi.org/10.1016/S2352-4642(20)30168-1

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