#15,230
Last Monday (see PICS: NHS Alert On Possible Severe Pediatric COVID-19 Complication), and again on Tuesday (see SMC: UK Experts Weigh In On NHS Pediatric Alert On COVID-19), we looked at early reports of a rare, and thus far unexplained, inflammatory disease in children which may - or may not - be related to COVID-19.
Since then there have been reports of a small number of similar cases in New York City, and elsewhere around the world. While some cases have tested positive for COVID-19, others have not.Yesterday the RCPCH (Royal College of Paediatrics and Child Health) published a case definition and preliminary guidance on the treatment of this condition.
Guidance - Paediatric multisystem inflammatory syndrome temporally associated with COVID-19
Health Policy team
Most children are asymptomatic or exhibit mild symptoms from COVID-19 infection. However, a small number have recently been identified who develop a significant systemic inflammatory response. This document for clinicians, which has been developed after expert review of the cases, includes a case definition and approach to clinical management.
Downloads
Guidance - COVID-19 paediatric multisystem inflammatory syndrome (1 May 2020)The case definition is understandably broad at this point, and will undoubtedly be refined going forward.
Case definition:
- A child presenting with persistent fever, inflammation (neutrophilia, elevated CRP and lymphopaenia) and evidence of single or multi-organ dysfunction (shock, cardiac, respiratory, renal, gastrointestinal or neurological disorder) with additional features (see listed in Appendix 1 ). This may include children fulfilling full or partial criteria for Kawasaki disease.
- Exclusion of any other microbial cause, including bacterial sepsis, staphylococcal or streptococcal shock syndromes, infections associated with myocarditis such as enterovirus (waiting for results of these investigations should not delay seeking expert advice).
- SARS-CoV-2 PCR testing may be positive or negative
All stable children should be discussed as soon as possible with specialist services to ensure prompt treatment (paediatric infectious disease / cardiology / rheumatology*).
There should be a low threshold for referral to Paediatric Intensive Care using normal pathways.
A news release from the RCPCH on this guidance follows:
Leading paediatricians publish case definition for illness affecting children during COVID-19
1 May 2020
Media & Campaigns team
Leading paediatricians in the UK have set out a working definition of an inflammatory syndrome affecting a very small number of children and which may be associated with COVID-19.
They hope that by more clearly describing what is currently known about the condition, doctors will be able to identify potential cases as quickly as possible to begin effective treatment.
Convened by the Royal College of Paediatrics and Child Health (RCPCH), the group has produced a case definition of the type of symptoms that may be seen in these children, the diagnostic tests to be used in potential cases, and the treatments to be given.
The expert group has stressed that it remains unclear whether COVID-paediatric multi-system inflammatory syndrome is caused by COVID-19 and reiterates that it has affected an extremely small number of children in the UK and throughout the world.
As knowledge about the condition continues to grow, the definition may change in the weeks and months ahead. Around 20 children in the UK and a small number across Europe, are thought to have had the condition. Of those who required intensive care, many have now made a good recovery although some still need very intensive therapy.
Possible cases have also been seen in the US and other countries. Why some countries have seen no cases remains unclear. It may be because of a lack of recognition of the syndrome, because doctors didn’t write up a case description, or because the condition is extremely rare.
Dr Mike Linney, paediatrician and RCPCH Registrar, said:
This new case description aims to include a range of all the possible symptoms and diagnostic information which doctors can use to make decisions about how to treat a child who may have the condition.
There is no one sign or symptom which alone would indicate that a child has the condition. Doctors can use the definition to look for a pattern of combined symptoms. All of these children were extremely unwell, with features suggestive of sepsis such as a persistently high temperature coupled with rapid breathing, cold hands and feet and sleepiness. The other symptoms varied greatly in the different cases.
Dr Sanjay Patel, consultant in paediatric infectious diseases at Southampton Children’s Hospital, said:
It’s very important to keep this in perspective. It’s a very rare condition and because of that parents shouldn’t be alarmed. We’re talking about a really small number of cases, each of which was picked up and treated by experts in our health system.
It remains extremely unlikely that a child will become unwell with COVID-19, and it’s even more unlikely that a child will become unwell with this condition. I want to reassure parents that our advice to them has not changed. If you have an unwell child, it probably isn’t anything to do with COVID and is more likely to be something else. If you’re concerned, do what you’d normally do. Call your GP, use NHS 111, or for emergencies – go to hospital.
NHS National Clinical Director for Children and Young People, Professor Simon Kenny said:
This is helpful guidance for frontline NHS staff on this condition. To be very clear to any worried parents out there, this remains very rare, and the advice remains the same as ever: if you are worried about your child for whatever reason, contact NHS 111 or your family doctor for urgent advice, or 999 in an emergency, and if a professional tells you to go to hospital, please do so immediately.
