Children's Hospitals Today - Spring 2022 - 31

5 MINUTES WITH... / VITALS
Nurses investigate MIS-C
These providers set out to learn as much as possible, and quickly.
BY GRANT HEIMAN
I
n May 2020, multi-system inflammatory
syndrome in children (MIS-C)
started presenting in pediatric populations.
With vague symptoms and potentially
severe manifestations, it was
important to learn as much as possible-
and quickly. Nurses from Children's
Hospital of Philadelphia (CHOP) were
among the first to better understand
MIS-C by conducting a literature review.
Kerry Shields, M.S.N., MBE, CRNP,
CPNP-AC, pediatric critical care nurse
practitioner, and Kristin Atlas, M.S.N.,
CRNP, CPNP-AC, ACCNS-P, a clinical
nurse specialist, discuss how they evaluated
this emerging syndrome.
How did your research start?
SHIELDS: The editor of American
Journal of Nursing approached Ruth
Lebet, a nurse scientist at CHOP, to
write a review article about MIS-C to
better describe and understand it. She
needed a clinical perspective, so we
were able to help.
ATLAS: This was all on a quick timeline
and early in the discovery of MIS-C.
We scoured databases to find anything
anyone was publishing, especially case
reports; new data and new information
would come out almost weekly, and it
was constantly changing.
SHIELDS: Initial publications were
small case reports from single institutions,
and there was no nomenclature
established, so defining a consistent
syndrome was difficult. It seemed like
the scope of the research was changing
every two days.
What are some of the key similarities
and differences between sepsis and
MIS-C you've identified?
ATLAS: The initial symptoms look like
Kristin Atlas (left), Kerry Shields and the rest of the team reviewed existing literature to
better understand MIS-C.
common illnesses we see in pediatrics:
GI symptoms, a fever, a rash and
fatigue. That's how many childhood
illnesses present, so taking common
symptoms and then narrowing the
options with more specific questions
is
important-especially
regarding
COVID-19 exposures and vaccination
status. We generally see MIS-C present
two to six weeks after a potential or
known COVID-19 exposure.
SHIELDS: The GI complaints were quite
profound, and that was different from
what we were seeing in other inflammatory
illnesses. In the workup of
MIS-C, there can be significant cardiac
dysfunction-myocarditis with left
ventricular
involvement. There were
certainly other multisystem manifestations,
but the care team needs to
have a high suspicion for cardiogenic
shock and how quickly a seemingly
well-appearing child can decompensate.
Specifically in MIS-C, children
can seem well-appearing with these
vague symptoms and then have a quick
change in their clinical appearance and
the interventions they're requiring.
ATLAS: When comparing MIS-C to sepsis,
one difference was the focus of the
diagnostic workup. With sepsis, we are
looking for the infectious source. With
MIS-C, we're trying to eliminate other
potential diagnoses and explain away
the other possibilities to definitively
diagnosis this syndrome, per the CDC
case definition.
How can children's hospitals better
equip themselves to care for kids
with MIS-C?
ATLAS: Identifying the resources and
organizations that are publishing
treatment guidelines is important.
Information changes quickly, on an
almost daily
basis, so know
where to find
current answers,
rather
than
relying on
memorization.
SHIELDS: It is
important to raise awareness. MIS-C
should be added into an already wide
differential, but it shouldn't take anything
away, so finding that balance
between something that is new while
not becoming too focused on one diagnosis
can be difficult.
Visit childrenshospitals
.org/miscsepsis and
watch " Multisystem
Inflammatory Syndrome
in Children or Sepsis?
Evaluating an Emerging
Syndrome " to learn more.
CHILDREN'S HOSPITALS TODAY Spring 2022
31

Children's Hospitals Today - Spring 2022

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