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Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19)

On May 14, the Centers for Disease Control and Prevention (CDC) issued a HAN alert on Multisystem Inflammatory Syndrome in Children (MIS-C) Associated with Coronavirus Disease 2019 (COVID-19).

"The Centers for Disease Control and Prevention (CDC) is providing 1) background information on several cases of a recently reported multisystem inflammatory syndrome in children (MIS-C) associated with coronavirus disease 2019 (COVID-19); and 2) a case definition for this syndrome. CDC recommends healthcare providers report any patient who meets the case definition to local, state, and territorial health departments to enhance knowledge of risk factors, pathogenesis, clinical course, and treatment of this syndrome."

Case Definition for Multisystem Inflammatory Syndrome in Children (MIS-C)

• An individual aged <21 years presenting with feveri, laboratory evidence of inflammationii, and evidence of clinically severe illness requiring hospitalization, with multisystem (>2) organ involvement (cardiac, renal, respiratory, hematologic, gastrointestinal, dermatologic or neurological); AND
• No alternative plausible diagnoses; AND
• Positive for current or recent SARS-CoV-2 infection by RT-PCR, serology, or antigen test; or COVID-19 exposure within the 4 weeks prior to the onset of symptoms

iFever >38.0°C for ≥24 hours, or report of subjective fever lasting ≥24 hours

iiIncluding, but not limited to, one or more of the following: an elevated C-reactive protein (CRP), erythrocyte sedimentation rate (ESR), fibrinogen, procalcitonin, d-dimer, ferritin, lactic acid dehydrogenase (LDH), or interleukin 6 (IL-6), elevated neutrophils, reduced lymphocytes and low albumin

Additional comments

• Some individuals may fulfill full or partial criteria for Kawasaki disease but should be reported if they meet the case definition for MIS-C
• Consider MIS-C in any pediatric death with evidence of SARS-CoV-2 infection

LATEST NUMBERS

• AAP Children and COVID-19: State-Level Data Report
• JOHNS HOPKINS COVID-19 CSSE Dashboard
• TEXAS DSHS COVID-19 Texas Case Counts

• PMI The Business Impact Of COVID-19 On Pediatric Practices
• AAP Child Abuse in the COVID-19 Era
• ACEP COVID-19: The Pediatric Perspective
• CHILDREN AT RISK Coronavirus Children's Resiliency Collaborative
• AAP Caring for Children with Complex Medical Conditions During COVID-19
• CHILDREN'S HEALTH Pediatric Insights: COVID-19 Insights for Providers
• NHTSA What EMS needs to know about COVID-19
• AAP Telehealth and COVID-19
• CDC Update for rural partners and communities
• CDC COVID-19 Information for Clinicians Caring for Children and Pregnant Women
• AAP COVID 19 Pandemic – Clinical Guidance for Pediatric Practices

• BW Airway/Respiratory Containment System: Open Source Device Reduce COVID-19 Occupational, developed by Texas Children's Hospital
• CDC Child Immunization Schedule Changes for 2020
• TMB Minimum Standards for Safe Practice Related to COVID-19
• ACEP COVID-19 Field Guide
• ACEP The Role of Emergency Physicians in the Care of Children
• CDC Hospital Preparedness Tool
• PEDIATRIC READINESS IN THE ED 2020 NPRP Checklist
• CMS COVID-19 Emergency Declaration Blanket Waivers for Health Care Providers
• ASPR COVID-19 Healthcare Planning Checklist
• AAP Management of Infants Born to COVID-19 Mothers FAQs
• AAP Guidance on Newborn Screening During COVID-19
• TEXAS DSHS COVID-19 & Newborn Screening
• TEXAS CHILDREN'S HOSPITAL Incoming Patients Screening Algorithm
• TEXAS CHILDREN'S HOSPITAL Caring for a COVID-19 Patient
• CDC Phone Advice Line Guidelines for Children or Adults with Possible COV

• EMSC/NHTSA Transporting Children in an ambulance
• EMS.GOV Managing Patient and Family Distress Associated with COVID-19
• ASPR EMS Infectious disease Playbook
• ASPR COVID-19 Healthcare Planning Checklist
• TX DSHS EMS Transporting Confirmed or Suspected COVID-19 Patients
• MEDSTAR High Consequence Infectious Disease Call Algorithm
• CMS Ambulances: CMS Flexibilities to Fight COVID-19
• CDC Interim Guidance for EMS and 911 PSAPs

SUPPORT FOR HEALTHCARE PROVIDERS

• COLLABORATIVE FOR CHILDREN Child care resources for essential employees
• FRONTLINE CHILDCARE Childcare Options for Texas Frontline Workers
• TDVR Volunteer Registry for Medical, Public Health and Lay Volunteer Responders

CONSIDERATIONS FOR PEOPLE WITH SPECIAL NEEDS

• TX COUNCIL FOR DEVELOPMENTAL DISABILITIES (TCDD) COVID-19 Resources
• TCCD Successful Communication with People with Disabilities
• TX EDUCATION AGENCY COVID 19 and Special Education FAQ
• ACEP Emergency Information Form for Children with Special Health Care Need (CSHCN)
• US DEPT. OF EDUCATION Providing services to CSHCN during COVID-19 FAQ

INJURY PREVENTION

CHILD ABUSE RESOURCES

Child abuse might go underreported during the pandemic as children spend more time at home then schools, where authorities rely on teachers and school nurses to report cases of potential child abuse. As shelter at home orders continue and schools remain closed, it remains everyone's responsibility to ensure that children feel safe in the environment they share with their families. Below are a few helpful resources.

• UNICEF Technical Guidance on Protecting Children During the Pandemic
• TEXAS DEPT. OF FAMILY AND PROTECTIVE SERVICES Abuse Hotline Website

VIDEO CHANNELS

OPENPediatrics is providing a collection of instructional videos to help healthcare providers care for pediatric patients during the pandemic.

MASSACHUSETTS EMSC has provided brief professional produced video clips for their Pediatric Emergency Care Coordinators (PECC). The video are meant to help professionals create a more family-centered environment for their emergency departments. In addition to helping children through minor procedures, the techniques presented in the videos also help the staff to feel more comfortable when a child presents requiring laceration repair, abscess I&D, etc.

FREE COURSES

• NC EMSC Pediatric Airway Course
• UNM SCHOOLS OF MEDICINE Pediatric Trauma Course
• OPENPEDIATRICS Ventilator Simulator

LATEST RESEARCH

• LANCET Steam inhalation and paediatric burns during the COVID-19 pandemic
• LANCET Hyperinflammatory shock in children during COVID-19 pandemic
• NEJM Children with Covid-19 in Pediatric Emergency Departments in Italy
• AAP COVID-19: Overview and Evaluation – Pediatric Collection
• CLINICS COVID-19 Diagnostic and Management Protocol for Pediatric Patients
• KARGER NEONATALOGY COVID-19 and Neonatal Resuscitation
• NEW ENGLAND JOURNAL OF MEDICINE (NEJM) SARS-CoV-2 Infection in Children
• DON'T FORGET THE BUBBLES Summary of pediatric COVID-19 literature

IN THE MEDIA

The Emergency Medical Services for Children (EMSC) State Partnership, Texas is a statewide collaborative project funded through the Health Resource and Services Administration’s EMS for Children Program. Baylor College of Medicine is the site of the Texas EMSC office and is working in partnership with the largest children’s hospitals in Texas, their affiliated colleges of medicine, and representatives of the Texas Department of State Health Services. Through this collaboration, the EMSC State Partnership, Texas has created the infrastructure to assess and achieve defined EMSC Performance Measures. In addition, the EMSC State Partnership, Texas works tirelessly to improve education, research and pediatric pre hospital care. For more information, please visit www.bcm.edu/pediatrics/emsc.

This information or content and conclusions are those of the author and should not be construed as the official position or policy of, nor should any endorsements be inferred by HRSA, HHS or the U.S. Government.

1102 Bates Ave Ste C1850 | Houston, TX 77030 | (832) 824 3672 | emsctexas@bcm.edu

Updated on May 18, 2020