NHS officials issued a high-priority alert last week warning of a rise in children presenting with a 'multisystem inflammatory state requiring intensive care'.
A warning circulated to GPs highlighted growing concern that the cases may be related to 'a SARS-CoV-2 related inflammatory syndrome emerging in children in the UK' or 'another as yet unidentified infectious pathogen'.
It remains unclear whether the cases are related to COVID-19 and the number of cases has been very limited. Experts from the Royal College of Paediatrics and Child Health (RCPCH) say that '20 children in the UK and a small number across Europe' are believed to have had the condition.
SARS-CoV-2 link
The college reports that among patients who required intensive care, some continue to require 'very intensive therapy - although many 'have now made a good recovery'.
The working case definition set out by the RCPCH says children may present with 'persistent fever, inflammation (neutrophilia, elevated CRP and lymphopaenia) and evidence of single or multi-organ dysfunction (shock, cardiac, respiratory, renal, gastrointestinal or neurological disorder) with additional features' that may include children 'fulfilling full or partial criteria for Kawasaki disease'.
A PCR test for SARS-CoV-2 'may be positive or negative', the advice says - and although other potential causes 'including bacterial sepsis, staphylococcal or streptococcal shock syndromes, infections associated with myocarditis such as enterovirus' should be considered, doctors should seek expert advice without waiting for test results to come back.
Paediatrician and RCPCH registrar Dr Mike Linney said: 'This new case description aims to include a range of all the possible symptoms and diagnostic information which doctors can use to make decisions about how to treat a child who may have the condition.
Child inflammatory syndrome
'There is no one sign or symptom which alone would indicate that a child has the condition. Doctors can use the definition to look for a pattern of combined symptoms. All of these children were extremely unwell, with features suggestive of sepsis such as a persistently high temperature coupled with rapid breathing, cold hands and feet and sleepiness. The other symptoms varied greatly in the different cases.'
NHS national clinical director for children and young people Simon Kenny said: 'This is helpful guidance for frontline NHS staff on this condition. To be very clear to any worried parents out there, this remains very rare, and the advice remains the same as ever: if you are worried about your child for whatever reason, contact NHS 111 or your family doctor for urgent advice, or 999 in an emergency, and if a professional tells you to go to hospital, please do so immediately.'
