Jun 3, 2020 COVID-19 and Children: What You Need to Know About the New Pediatric Multi-System Inflammatory Syndrome

Jennifer Owensby, MD, Interim Medical Director, Pediatric Intensive Care, Bristol-Myers Squibb Children’s Hospital at Robert Wood Johnson University Hospital and Assistant Professor of Pediatrics at Rutgers Robert Wood Johnson Medical School and
Joseph W. Gaffney, MD
, Division Chief, Pediatric Cardiology, Rutgers Robert Wood Johnson Medical School

In recent weeks hospitals in New York and New Jersey, along with Europe and other parts of the US, have seen an increase in pediatric patients have been presenting more and more with this new pediatric multi-system inflammatory that has links to COVID-19.

What is pediatric multi system inflammatory syndrome and how does it differ from Kawasaki disease?
Pediatric multi-system inflammatory syndrome is an inflammatory disease we’re seeing emerge in recent weeks. While it has some similarities to Kawasaki disease, this new syndrome presents itself in different ways than Kawasaki disease. Symptoms of the COVID-19 related pediatric multi-system inflammatory disease includes:

  • A high fever that lasts greater than five days
  • Conjunctivitis
  • A rash over the body
  • Strawberry tongue – where the tongue turns a beefy red color and swells
  • Abdominal pain
  • Prolonged diarrhea
  • Shock
  • Heart failure
  • Fatigue
  • Shortness of breath

What ages are being affected?
This new pediatric multi-system inflammatory syndrome, is affecting mostly older children – from school aged, adolescents and teenagers with some younger children.

How is this new pediatric multi-system inflammatory syndrome related to COVID-19?
The relationship between pediatric multi-system inflammatory syndrome and COVID-19 is unclear at this time. So far, we know we have patients who were COVID-19 infected and are now developing this pediatric multi-system inflammatory syndrome but the cause and effect are not clear. We’re seeing a strong association between the two.

What are the risks / complications of this syndrome?
There is still a lot unknown at this time about the new COVID-19 related pediatric multi-system inflammatory syndrome, so many of the long-term risks or complications are still unclear. We’re concerned the biggest and most dangerous risk is development of myocarditis, or inflammation of the muscle layer of the heart wall. This can lead to poor heart function resulting in low blood pressure and shock. Some patients can develop dilated coronary arteries, though most do not.

Is this new syndrome fatal?
Unfortunately, there have been a small number of fatalities, three in New York and one in England but it’s important to keep in mind that it is a treatable syndrome with so far, mostly good outcomes.

What’s the treatment?
With this new pediatric multi-system inflammatory syndrome, we are taking a three-pronged approach. We are treating the patients who come in with shock and low blood pressure with cardiac medications and fluids, we’re treating the inflammation with steroids and gamma globulin and then if necessary, we’re treating the COVID-19 with remdesivir or convalescent plasma from recovered patients. Early and aggressive treatment is essential.

At what point should parents seek medical care?
The patients we’re seeing come in for the pediatric multi-system inflammatory syndrome come in very, very sick. Do not delay treatment if you think your child is ill. Parents should seek medical attention for children as soon as parents notice symptoms of prolonged fever, conjunctivitis, rash, and strawberry tongue – as well as if their child has prolonged diarrhea, abdominal pain, fatigue and shortness of breath. Parents should not be afraid to bring their children to the hospital because of COVID-19. Hospitals are very careful, safe and clean and there are designated non-COVID-19 treatment floors. Do not wait until your child is really sick. Get medical attention as soon as you recognize symptoms.

Can you make a full recovery?
The majority of patients we’ve seen are recovering and going home. We still do not know enough about this new syndrome to know whether there will be long-term consequences.