Page 168 - Abstract Book KONIKA 18

Emergency & Pediatric Intensive Care

P-EPIC-015
Two Cases of Multisystem Inflammation Syndrome in Children:
To Be or Not to Be Kawasaki Disease-Like

Ririe Fachrina Malisie, Hafaz Zakky Abdillah, Ayodhia Pitaloka Pasaribu
Child Health Department Medical Faculty Universitas Sumatera Utara, North Sumatera, Indonesia

Abstract
Background The multisystem inflammatory syndrome in children associated with Coronavirus Disease
(COVID-19) named by CDC and WHO. Several studies have demonstrated the link between Kawasaki's
disease and COVID-19 while some publications have not confirmed this relationship. It suggested that
pathogenesis is related to host immune response and hyperinflammation. Objective To describe two cases in
female toddler 4-years-old and 1.5-months-old infant diagnosed with MIS-C. Cases The first case presented
high grade fever for several days before admission, non-purulent conjunctivitis, strawberry tongue and rash.
There were increasing of C-reactive protein, procalcitonin, IL-6, ferritin, elevated of D-dimer, and antibody
of SARS-CoV-2. Her initial echocardiogram described minimal pericardial effusion. She was treated with
intravenous methylprednisolone, IVIG and aspirin. The fever diminished 48 hours after completion of
IVIG. On the ambulatory department, her follow-up echocardiogram showed improvement in two weeks
interval and no respiratory complications. The second case suffered fever and severe respiratory distress.
The test of Ig G of SARS-CoV-2 was reactive but negative Polymerase Chain Reaction of SARS Co-V-
2. Inflammation markers, cardiac enzymes and coagulation were increased significantly. The chest x-ray
appeared bilateral infiltrates. She treated on mechanical ventilation and Vasoactive-Inotropic Score > 10.
Electrocardiography showed Right Bundle Branch Block meanwhile echocardiography assessment described
the dilatation of right atrial and myocarditis, before she have cardiac arrest and unsuccessful resuscitation.
Conclusion The two cases of MIS-C have showed the differentiation of clinical symptoms, severity and
laboratory presents between Kawasaki Disease-like or not.
Keywords: MIS-C; COVID-19; Kawasaki disease-like

P-EPIC-016
Patient Characteristic with High Flow Nasal Cannula Therapy
in Pediatric Intensive Care Unit DR Mohammad Hoesin Hospital Palembang

Tessa Rulianty, Desti Handayani, Indra Saputra, Silvia Triratna
Department of Child Health, Faculty of Medicine Universitas Sriwijaya, Mohammad Hoesin General Hospital,
Palembang, South Sumatera, Indonesia

Abstract
Background High flow nasal cannula (HFNC) is increasingly utilized in paediatrics, delivering humidified air
and oxygen for respiratory conditions causing hypoxia and distress. Few data exist regarding indications and
characteristic patient that warrants HFNC in Pediatric Intensive Care Unit (PICU). Objective To identify the
characteristic and outcome of patients with HFNC in PICU Mohammad Hoesin General Hospital Palembang.
Methods The clinical data of patients admitted to PICU with HFNC from March until June 2021 were
reviewed. All children, from 1 month to 18 years of age, with acute respiratory distress and HFNC therapy
were eligible. Results There were 34 subjects included in the study which represented 23,7% of total ICU
admissions, 23/34 were male, median age was 36 (range 1-204) months. Majority of nutritional status was
normal (13/34). HFNC therapy were used in pneumonia (18/34), neurologic diseases (5/34), post-extubation
support (5/34), nephrology diseases (5/34), cardiac failure (1/34). Initial SpO2/FiO2 ratio <250 were found in
33/34 subjects, except for one subject who had abnormal ventilation. HFNC was used successfully in 25/34
patients with mean usage time 2.97 (SD 1) day. Conclusion HFNC was mostly indicated in pneumonia, and
successfully used in more than half subjects.
Keywords: high-flow nasal cannula; child; respiratory distress, paediatric intensive care unit

120 KONIKA XVIII Abstract Book