Children At Higher Risk Of Multi-Organ Failure Following Covid Infection New Studies Reveal

source – cleveland clinic
  • A four-year-old boy is in the children’s intensive care unit, with mechanical ventilation supporting his breathing. 

  • The Singapore Ministry of Health (MOH) revealed on Saturday (Nov 6) that four children out of 8,000 paediatric Covid-19 patients had acquired Multi-System Inflammatory Syndrome In Children (MIS-C).

Children At Higher Risk Of Multi-Organ Failure Following Covid Infection New Studies Reveal

Since early 2020, paediatricians in Singapore seem to have been tracking a rare and severe inflammatory disease that affects children infected with Covid-19.

A group of four physicians from KK Women's and Children's Hospital stated in a letter to the Journal of Paediatrics in November 2020 that there was no notable rise in the number of children with Kawasaki disease symptoms during the early months of the Covid-19 pandemic.

In response to an article about 33 children with Multi-System Inflammatory Syndrome In Children (MIS-C) in New York City, they compared the rate of incidence between January 2017 and December 2019 with the interval between January 2020 and April 2020.

Kawasaki disease, which causes inflammation in blood vessels all through the body and primarily affects children under the age of five, exhibits symptoms similar to MIS-C.

The Singapore Ministry of Health (MOH) revealed on Saturday (Nov 6) that four children out of 8,000 paediatric Covid-19 patients had acquired MIS-C.

A four-year-old boy is in the children's intensive care unit, with mechanical ventilation supporting his breathing.

MIS-C is a disorder in which various body organs, such as the heart, lungs, kidneys, brain, and eyes, may become inflamed.

More than a year later, research on MIS-C is still ongoing, with many questions yet unaddressed.

According to research published in The Lancet medical journal in May this year, it normally develops two to six weeks after a child has been infected with Covid-19.

After being discharged from the hospital for the initial infection, some children acquire MIS-C.

In other cases, children who had never needed to be admitted for the initial illness (covid) were instead admitted for MIS-C.

Leong Hoe Nam, an infectious diseases specialist, characterized MIS-C as “an abnormal, uncharacterised (and) little-known phenomenon" that might cause lasting organ damage.

“Put simply, it is an inappropriate exuberant immune response for a seemingly innocuous viral infection for any other child," he told The Straits Times.

Dr. Leong went on to say that the delayed onset is due to the time it takes for an immune response to Covid-19 to develop, similar to how someone gets fully vaccinated just two weeks after being injected with the vaccine.

source - healthline

Another Lancet study, published in November 2020, found a surge in inflammatory illness four to six weeks after Covid-19 cases increased in Europe and the United States.

Obesity, according to Dr. Liew Woei Kang, a paediatric immunology specialist, is the biggest risk factor for MIS-C found so far.

Certain races, such as Black people in the United States, are also over-represented in MIS-C statistics.

Though the aetiology of MIS-C is unclear, it is usually encountered following a recent Covid-19 infection and is therefore assumed to be a post-infectious immunological phenomenon, according to Dr. Liew.

According to the Ministry of Health, the symptoms of MIS-C include a persistent fever of 38.5 degrees Celsius or higher for three days or more, difficulty breathing, headache, neck swelling, rash, swollen hands and feet, or abdominal pain.

source - shutterstock

To manage the “exuberant" immune response and its implications on the child, doctors may prescribe steroids, aspirin, and intravenous gamma globulin to treat MIS-C, according to Dr Leong.

According to Dr Liew, consultant paediatrician at the Paediatric Allergy Immunology Rheumatology Centre, “the treatment of MIS-C is largely supportive, targeting the organs that have been affected. As a large percentage of MIS-C patients have low blood pressure, many require intensive care unit admission and cardiac medications."

According to the Ministry of Health, MIS-C exhibits symptoms similar to Kawasaki disease, which has been linked to numerous viral or bacterial infections and affects 150 to 200 children in Singapore each year.

According to Dr. Liew, MIS-C and Kawasaki disease may have overlapping clinical symptoms. However, he emphasised that research in the United States show that MIS-C may impact people of all ages.

Children with MIS-C also have more significant gastrointestinal and neurological symptoms, present with low blood pressure more often, and are more likely to have cardiac failure than children with Kawasaki disease.

He added: “The key signature of MIS-C is the presence of excessive and inappropriate inflammation of the body which results in adverse effects in multiple organs."

source - CNA

Dr. Liew went on to say that although there are parallels between MIS-C and severe Covid-19 infection, there are also significant distinctions, and doctors are still researching about both of these novel diseases.

Dr. Leong, an infectious diseases expert at Rophi Clinic, stated that “we should wait for the Health Sciences Authority's (full) approval", when asked about covid vaccination in children.

“Trust our own doctors to make an informed recommendation on the suitability for children."

According to Dr. Liew, parents should be aware of the signs of MIS-C, which include persistent fever, rash, red eyes, abdominal pain, vomiting, diarrhoea, dizziness, or difficulty breathing.

“While these are non-specific symptoms and can be present in common infections, red flags should be raised if the child is unwell and has recently recovered from Covid-19 infection.”

“The best measure to prevent MIS-C is to avoid contracting Covid-19 infection. Thus, appropriate personal hygiene, wearing mask outdoors and social distancing measures are recommended."

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