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Multisystem Inflammatory Syndrome in pediatric COVID-19 patients: A meta-analysis
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  • Mohammad Hussein,
  • Rami Elshazli,
  • Adam Kline,
  • Ruhul Munshi,
  • Nasrin Sultana,
  • Sharven Taghavi,
  • Mary Killackey,
  • Juan Duchesne,
  • Eman Toraih,
  • Manal Fawzy,
  • Emad Kandil
Mohammad Hussein
Tulane University School of Medicine
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Rami Elshazli
Horus University
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Adam Kline
Tulane University School of Medicine
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Ruhul Munshi
Tulane University School of Medicine
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Nasrin Sultana
Larkin Community Hospital Inc
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Sharven Taghavi
Tulane University School of Medicine
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Mary Killackey
Tulane University School of Medicine
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Juan Duchesne
Tulane University School of Medicine
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Eman Toraih
Tulane University School of Medicine
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Manal Fawzy
Suez Canal University Faculty of Medicine
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Emad Kandil
Tulane University School of Medicine
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Abstract

Purpose Significant numbers of children and teenagers with COVID-19 have developed a severe inflammatory condition with a Kawasaki-like disease. Some needed intensive care unit admission, and others recovered quickly. We aimed to summarize the clinical and laboratory features of patients with Kawasaki-like features diagnosed during the COVID-19 pandemic. Methods A literature search in Web of Science, PubMed, Scopus, and Science Direct up to June 30, 2020. The mean or untransformed proportion and 95%CI were estimated. Results Analysis of 15 articles (318 COVID-19 patients) revealed that the mean age was 9.10 years. Although many presented with typical Kawasaki-like features; fever (82.4%), polymorphous maculopapular exanthema (63.7%), oral mucosal changes (58.1%), conjunctival injections (56.0%), edematous extremities (40.7%), and cervical lymphadenopathy (28.5%), atypical gastrointestinal (79.4%) and neurocognitive symptoms (31.8%) were also common. They had elevated LDH, D-dimer, CRP, procalcitonin, interleukin-6, troponin I levels, and lymphopenia. Nearly 77.0% developed hypotension, and 68.1% went into shock, while 41.1% had acute kidney injury. Intensive care was needed in 73.7% of cases, 13.2% were intubated, and 37.9% required mechanical ventilation, with only one reported fatality case. Intravenous immunoglobulins and steroids were given in 87.7% and 56.9% of the patients, and anticoagulants were utilized in 67.0%. Pediatric patients were discharged after a hospital stay of, on average, 6.77 days (95%CI:4.93-8.6). Conclusion Recognizing the typical and atypical presentation of pediatric COVID-19 patients has important implications in identifying children at risk. Monitoring cardiac and renal decompensation and early interventions in patients with “multisystem inflammatory syndrome” is critical to prevent further morbidity.

Peer review status:UNDER REVIEW

04 Aug 2020Submitted to Pediatric Pulmonology
05 Aug 2020Assigned to Editor
05 Aug 2020Submission Checks Completed
07 Aug 2020Reviewer(s) Assigned
18 Aug 2020Review(s) Completed, Editorial Evaluation Pending