The WHO has today published updated guidelines on the treatment of multisystem inflammatory syndrome in children associated with COVID-19 (MIS-C), a sequela that can severely damage the heart of affected children, and make them need to be monitored for life. .
MIS-C is a rare but serious condition in which children with COVID-19 develop inflammation that affects different organs in the body. Children with this condition need specialized care and may need to be admitted to intensive care. Although MIS-C is a serious condition, with proper medical care, children with this condition do well.
In hospitalized children aged 0 to 18 years who meet a standard case definition for MIS-C, the WHO suggests the use of corticosteroids instead of IVIG
The WHO first described this condition in May 2020 and provided a preliminary clinical definition.
Updated WHO guidelines recommend the use of corticosteroids in hospitalized children (aged 0-18 years) with this condition, in addition to treatment and supportive care. This recommendation arises after the availability of three observational studies, which pooled data from a total of 885 patients.
Little certainty in the benefit of corticosteroids
These three studies looked at the effects of these three comparisons:
- adding corticosteroids to intravenous immunoglobulin (IVIg) therapy compared to IVIg alone;
- corticosteroids compared to IVIg;
- adding corticosteroids to IVIG compared to corticosteroids alone
And for all prioritized outcomes, including death, need for invasive mechanical ventilation 2 days after start of treatment, need for hemodynamic support 2 days after start of treatment, coronary artery dilatation, acute left ventricular dysfunction 2 days after start of treatment, initiation of treatment and fever reduction 2 days after initiation of treatment, the evidence was of very low certainty.
In any case, for all these reasons it is a conditional recommendation, since as the WHO itself warns in its guide, “it is not so clear whether the benefits clearly outweigh the drawbacks. This means that most patients would choose the recommended treatment. However, there is a high possibility of variability in individual preferences.”
In general, children remain at low risk of developing severe or critical COVID-19, but like adults, certain underlying conditions make children more susceptible to serious illness. The most commonly reported of these conditions are obesity, chronic lung disease (including asthma), cardiovascular disease, and immunosuppression.
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