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COVID-19-related disease sends more than two dozen children to LI hospitals

About 25 children have been treated at Cohen

About 25 children have been treated at Cohen Children's Medical Center in New Hyde Park for what is called the "pediatric multi-system inflammatory syndrome potentially associated with COVID-19." Credit: Newsday File/Yeong-Ung Yang

An inflammatory disease linked to COVID-19 has landed more than two dozen children in Long Island hospitals in the past two weeks, some in intensive care, hospitals and doctors said.

The state Department of Health issued an advisory Wednesday that urges hospitals to immediately report cases of what is called "pediatric multi-system inflammatory syndrome potentially associated with COVID-19," and to perform a test for the coronavirus. There were 64 cases in the state as of Tuesday, and similar cases have been reported outside the state, including in Europe, the advisory said.

The syndrome appears to stem from the kids’ immune systems' “hyperactive response” to the coronavirus infection, which then leads to inflammation of blood vessels and complications that have included inflamed heart muscles and breathing problems, said Dr. James Schneider, chief of pediatric critical care at Cohen Children’s Medical Center in New Hyde Park.

Most at Cohen have been so seriously ill that they required critical care treatment, he said. Schneider said none of the children at Cohen have died, and he is unaware of any deaths from the syndrome elsewhere.

About 25 children have been treated for the syndrome at Cohen, and most previously had been healthy, he said.

“This is a disease that’s barely two weeks old,” and why it affects a small number of children who contract the coronavirus but not the large majority is still unknown, Schneider said.

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The syndrome is emerging in some cases a few weeks after a child is believed to have contracted the coronavirus, and some of the kids with the syndrome tested negative for the coronavirus but positive for antibodies that the body creates in response to the virus, he said.

A 4-year-old boy Dr. Leonard Krilov treated for the syndrome at NYU Winthrop Hospital in Mineola had a high fever, rash, abdominal pain and inflammation in his kidneys about two to three weeks after he had mild respiratory issues and his parents had COVID-19 symptoms, Krilov said.

Within 24 hours after receiving intravenous immunoglobulin — a part of the blood’s plasma with antibodies — he improved markedly, Krilov said.

“Fortunately, it reversed itself before there were any major injuries,” he said.

Intravenous immunoglobulin is also a standard treatment for Kawasaki disease, said Krilov, an expert on Kawasaki, which has symptoms that overlap with the syndrome’s, such as inflammation of the lips, tongue and eyes, and rashes.

But there are key differences, he said. Kawasaki disease typically strikes children 1 to 3 years old, while the syndrome is reported primarily in children ages 4 to 12.

The syndrome’s effect in some cases on the cardiovascular system and other problems more often lead to a need for intensive care treatment than with Kawasaki disease, Schneider said. The cause of Kawasaki disease is unknown.

With some of the children with the syndrome, there is evidence of inflammation of the heart muscles or inflammation of the coronary arteries, and the latter in the long term could lead to serious heart damage, including heart attacks, if left untreated, he said.

A 10-year-old boy treated at Stony Brook Children’s Hospital had some symptoms linked to Kawasaki, along with significant vomiting, diarrhea and low blood pressure, said Dr. Christy Beneri, director of pediatric infectious diseases at the hospital.

Beneri said his treatment with tocilizumab, which “helps to knock down that overactive inflammatory response,” probably benefited him. The boy went home Saturday.

Like a number of other children with the syndrome, the boy needed help breathing, in his case with tubes that delivered oxygen through his nose, Beneri said. The boy had fluid in his lungs, she said.

Children at Cohen also required nasal prongs, or oxygen masks, and in a few cases ventilators, Schneider said.

In adults with COVID-19, breathing problems typically stem from a lung infection, he said.

But with children that have the syndrome, “If they have breathing difficulties, it’s usually because of this inflammatory response that’s affecting the whole body ... The lungs themselves are [typically] not primarily infected.”

The children, though, can then develop lung disease from the inflammation that occurs, he said.

Most children who contract the coronavirus have either had no symptoms or mild symptoms, worldwide research shows. Krilov said he doesn’t expect the emergence of the syndrome to change that.

“I don't think it's going to go from 64 cases and take off and reach huge, huge numbers,” he said. “I think it's important to watch out for it because it can be serious and needs to be monitored and treated. But I think it's still a rare anomaly.” 

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