SARS-CoV-2 is a novel cause of organ dysfunction in children, presenting as either coronavirus disease 2019 with sepsis and respiratory failure or a hyperinflammatory shock syndrome. The SSC International Guidelines for the Management of Sepsis-associated Organ Dysfunction and Septic Shock in Children provide an appropriate framework for the initial resuscitation and early recognition of children with septic shock or sepsis caused by all pathogens including SARS-CoV-2.
The studies conducted in the United States of America, China, and Italy found that 2% of cases occurred in those less than 19 years old, translating to 90 thousand known COVID-19 illnesses in children. Approximately 7% of these children have presented with or developed severe COVID-19 with myocardial dysfunction, pediatric acute respiratory distress syndrome (PARDS), shock, multiple organ dysfunction syndromes, or altered mental status. Organ dysfunctions triggered by SARS-CoV-2 should be considered a phenotype of pediatric sepsis or septic shock. More recently, there has been a surge in children presenting with hyperinflammatory shock resembling atypical Kawasaki disease, Kawasaki-shock, and toxic shock syndrome, alternatively termed Pediatric Inflammatory Multisystem Syndrome Temporally associated with SARS-Covid infection (PIMS-TS) or Multisystem Inflammatory Syndrome in Children (MIS-C).
In conclusion, physicians should carefully augment and tailor these guidelines as knowledge and experience develop about the unique ways in which SARS-CoV-2 leads to respiratory failure, hyperinflammatory shock, and sepsis in children.
