COVID-19 ile İlişkili Pediatrik Multisistem İnflamatuar Sendromu ve Hemşirelik Yaklaşımı

Abstract

Multisistem İnflamatuar Sendromu (Multisystem Inflammatory Syndrome in Children / MIS-C), COVID-19’un nadir görülen komplikasyonu olarak tanımlanan, Nisan 2020 tarihinden itibaren COVID-19 geçirildikten 2-4 hafta sonra ortaya çıktığı varsayılan bir sendromdur. MIS-C’de; sıklıkla ateş, döküntü, bilateral konjonktivit, gastrointestinal sisteme ait semptomlar, aşırı yorgunluk hissi veya miyokardit gibi bulgular görülmektedir. Hemşireler pediatrik hastaların fiziksel, mental ve spiritüel ihtiyaçlarını anlayarak ve karşılayarak bütüncül bir yaklaşımla kaliteli, bireyselleştirilmiş ve aile merkezli bakım vermeye özen göstermelidir. Bakımda izolasyon önlemleri alınmalı ve uygun kişisel koruyucu ekipmanlar kullanılmalı, kişisel koruyucu ekipmanlara yönelik çocuk ve ailenin eğitimi bakımın bir parçası olmalıdır. MIS-C yeni bir sendrom olduğundan sağlık ekibi üyeleri, pediatrik hastaların ve ailelerinin birçok sorusu ile karşı karşıya kalacaklarından bu süreçte literatürü takip etmeleri oldukça önemlidir. Bu derlemede, 2021 Ocak – Şubat aylarında PubMed veritabanında yer alan COVID-19 ile ilişkili MIS-C tanılı hastaların olgu sunumlarındaki hastalığın seyri ve buna yönelik hemşirelik yaklaşımı ele alınmıştır.

Keywords

• COVID-19
• hemşirelik
• pediatri
• multisistem inflamatuar sendromu.

Pediatric Multisystem Inflammatory Syndrome Related to COVID-19 and Nursing Approach

Abstract

Multisystem Inflammatory Syndrome (MIS-C) is a syndrome defined as a rare complication of COVID-19, which is assumed to occur 2-4 weeks after COVID-19 as of April 2020. In MIS-C, symptoms such as fever, rash, bilateral conjunctivitis, symptoms of the gastrointestinal system, feeling of extreme tiredness or myocarditis are frequently observed. Nurses should take care to provide quality, individualized and family- centered care in a holistic approach by understanding and meeting the physical, mental, and spiritual needs of pediatric patients. Isolation measures should be taken care of, appropriate personal protective equipment should be used, and education of the child and family should be a part of the care for personal protective equipment. It is very important for healthcare members to follow the literature in this process, as they will face many questions from patients and their families. In this review, the course of the disease and the nursing approach to this in the case reports of patients with a diagnosis of MIS-C associated with COVID-19 in the PubMed database between January and February 2021 were discussed.

Keywords

• nursing
• pediatrics
• COVID-19
• multisystem inflammatory syndrome.

References

1. Son MB, Friedman K. Coronavirus disease 2019 (COVID-19): multisystem inflammatory syndrome in children. Up to Date. 2020.
2. World Health Organisation [İnternet]. Multisystem inflammatory sydrome in children and adolescents with Covid-19;2020 [cited 2021 10 Feb 10]. Available from: https://www.who.int/news-room/commentaries/ detail/multisystem-inflammatory-syndrome-in-children-and- adolescents-with-covid-19
3. Panigrahy N, Policarpio J, Ramanathan R. Multisystem inflammatory syndrome in children and SARS-CoV-2: A scoping review. J Pediatr Rehabil Med. . 2020;13(3):301-16. doi: 10.3233/PRM-200794
4. Centers for Disease Control and Prevention [İnternet]. Information for healthcare providers about multisystem inflammatory syndrome in children (MIS-C);2021 [cited 2021 Feb 9]. Available from: https://www.cdc. gov/mis-c/hcp/
5. Godfred-Cato S, Bryant B, Leung J, Oster ME, Conklin L, Abrams J, et al. COVID-19–associated multisystem inflammatory syndrome in children— United States, March–July 2020. Morbidity and Mortality Weekly Report. 2020;69(32):1074. doi: 10.15585/mmwr.mm6932e2.
6. T.C. Sağlık Bakanlığı [İnternet]. Covid-19 (SARS-CoV-2 enfeksiyonu bilim kurulu çalışması) çocuk hasta yönetimi ve tedavi;2020 [cited 2020 Mar 15]. Available from: https://covid19.saglik.gov.tr/Eklenti/38596/0/covid-19reh bericocukhastayonetimivetedavipdf.pdf
7. Centers for Disease Control and Prevention [İnternet]. Health department-reported cases of multisystem inflammatory syndrome in children (MIS-C) in the United States;2021 [cited 2021 Feb 9]. Erişim linki: https://www.cdc.gov/mis-c/cases/index.html
8. Çiftçi E, Arga G, Çakmak Taşkın E, Konca HK, Özdemir H. COVID-19 ilişkili çocuklarda multisistem inflamatuar sendromu (MIS-C). J Pediatr Inf. 2020;14(4):261.

9. Türk MOK, Akkuş CH, Atay G, Erdoğan S, Çakır D, Salı E, et al. Therapeutic plasma exchange (TPE) treatment in COVID-19 related Multisystem inflammatory syndrome in children (MIS-C) who admitted with acute abdomen clinic. Jour Umraniye Pediatr. 2021; 1(1):14–19 doi: 10.14744/ upd.2020.03522
10. Hageman JR. What are the newest effects of COVID-19 in children? Pediatric Annals. 2020;49(6):e242-3. https://doi.org/10.3928/19382359- 20200520-02
11. Saguil A, Fargo M, Grogan S. Diagnosis and management of Kawasaki disease. Am Fam Physician. 2015;91(6):365-71. https://www.aafp.org/ afp/2015/0315/p365.html
12. McCrindle BW, Rowley AH, Newburger JW, Burns JC, Bolger AF, Gewitz M, et al. Diagnosis, treatment, and longterm management of Kawasaki disease: A scientific statement for health professionals from the American Heart Association. Circulation. 2017;135(17):e927-99. https://doi. org/10.1161/CIR.0000000000000484
13. Hennon TR, Penque MD, Abdul-Aziz R, Alibrahim OS, McGreevy MB, Prout AJ, et al. COVID-19 associated multisystem inflammatory syndrome in children (MIS-C) guidelines; A Western New York approach. Prog. Pediatr. Cardiol. . 2020;57:101232. https://doi.org/10.1016/j. ppedcard.2020.101232
14. Centers for Disease Control and Prevention [İnternet]. Multisystem Inflammatory Syndrome (MIS-C);2020 [cited 2021 Feb 9]. Available from: https://www.cdc.gov/mis-c/#:~:text=What%20is%20 MIS%2DC%3F,%2C%20eyes%2C%20or%20gastrointestinal%20organs.
15. Turan KC, Hacımustafaoğlu MK. Çocuklarda Coronavirus Hastalığı 2019 (COVID-19): Çocuklarda Farklılıklar ve Yaklaşım. In: Heper C, editor. Multidisipliner COVID-19 Bursa Tabip Odası Sürekli Tıp eğitimi Pandemi Kitabı. Bursa: Bursa Tabip Odası Yayınları; 2020. p.82-92.
16. Jackson RJ, Chavarria HD, Hacking SM. A Case of Multisystem Inflammatory Syndrome in Children Mimicking Acute Appendicitis in a COVID-19 Pandemic Area. Cureus. 2020;12(9): e10722. doi: 10.7759/ cureus.10722.
17. Bahrami A, Vafapour M, Moazzami B, Rezaei N. Hyperinflammatory shock related to COVID‐19 in a patient presenting with multisystem inflammatory syndrome in children: first case from Iran. J Paediatr Child Health. . 2020. doi: 10.1111/jpc.15048.
18. Fouriki A, Fougère Y, De Camaret C, Rohner GB, Grazioli S, Wagner N, et al. Case Report: Case Series of Children With Multisystem Inflammatory Syndrome Following SARS-CoV-2 Infection in Switzerland. Front Pediatr. . 2021;8. doi: 10.3389/fped.2020.594127.
19. Naguib MN, Raymond JK, Vidmar AP. New onset diabetes with diabetic ketoacidosis in a child with multisystem inflammatory syndrome due to COVID-19. J. Pediatr. Endocrinol. Metab. . 2021;34(1):147-50. doi: 10.1515/jpem-2020-0426.
20. Greene AG, Saleh M, Roseman E, Sinert R. Toxic shock-like syndrome and COVID-19: Multisystem inflammatory syndrome in children (MIS-C). Am. J. Emerg. Med. 2020;38(11):2492-e5. doi: 10.1016/j.ajem.2020.05.117
21. Kim H, Shim JY, Ko JH, Yang A, Shim JW, Kim DS, et al. Multisystem inflammatory syndrome in children related to COVID-19: the first case in Korea. J Korean Med Sci. 2020;35(43). doi: 10.3346/jkms.2020.35.e391
22. Alsabri M, Sakr M, Qarooni S, Hassanein MM. COVID-19 Infection in a Child Presenting With Functional Intestinal Obstruction. Cureus. 2020;12(11). doi: 10.7759/cureus.11448
23. MaGowan N, Darcy J, Mosiello A, Gomes C, Miller N. Navigating through the uncharted territory of multisystem inflammatory syndrome in children (MIS-C): What the pediatric clinical nurse must know. Pediatr. Nurs. 2020;46(6):273-7.
24. Aydemir Gedük E. Hemşirelik mesleğinin gelişen rolleri. Sağlık Bilimleri ve Meslekleri Dergisi. 2018;5(2):253-8. doi: 10.17681/hsp.358458
25. Balcı S, Yıldırım Balkan Z. Yenidoğan yoğun bakım ünitesinde aile merkezli bakım. In: Geçkil E, editor. Pediatri hemşireliğinde aile merkezli bakım. 1. Baskı. Ankara: Türkiye Klinikleri; 2019. p.18-23.
26. Yılmaz ÖE, Gözen D. Pediatri hemşireliğinde aile merkezli bakımın önemi ve bakım kalitesini geliştirmedeki değeri. In: Geçkil E, editor. Pediatri hemşireliğinde aile merkezli bakım. 1. Baskı. Ankara: Türkiye Klinikleri; 2019. p.5-11.
27. American College of Rheumatology [İnternet]. Clinical guidance for pediatric patients with multisystem inflammatory syndrome in children (MIS-C) associated with SARS-CoV-2 and hyperinflammation in COVID-19;2020 [cited 2021 Feb 1]. Available from: https://www. rheumatology.org/Portals/0/Files/ACRCOVID-19-Clinical-Guidance- Summary-MIS-C-Hyperinflammation.pdf
28. Belhadjer Z, Méot M, Bajolle F, Khraiche D, Legendre A, Abakkam S, et al. Acute heart failure in multisystem inflammatory syndrome in children (MIS-C) in the context of global SARSCoV-2 pandemic. Circulation. 2020;142(5):429-36. https://doi.org/10.1161/ CIRCULATIONAHA.120.048360
29. Campbell N. Recognising and preventing dehydration among patients. Nurs Times. 2014;110(46):20-1.
30. Sert H, Olgun, N. Yoğun Bakımda Ödem ve Dehidratasyon. Yoğun Bakım Hemşireliği Dergisi. 2016;20(1):24-36.
31. Adan A. Cognitive performance and dehydration. J Am Coll Nutr. 2012;31(2):71-8.
32. Carpenito-Moyet LJ, eds. Erdemir F, çeviri editörü. Hemşirelik Tanıları El Kitabı. Nobel Tıp Kitapevleri; 2012. p.418-21.
33. Kapucu S, Akyar İ, Korkmaz F, çeviri editörleri. Pearson Hemşirelik Tanıları. In: Wilkinson JM, Barcus, L, eds. Pelikan Yayınevi; 2018. p.137- 42;185-9;196-202;910-914;953-958.
34. Chiappini E, Principi N, Longhi R, Tovo PA, Becherucci P, Bonsignori F, et al. Management of fever in children: summary of the Italian Pediatric Society guidelines. Clin Ther. 2009;31(8):1826-43. doi: 10.1016/j. clinthera.2009.08.006.
35. Kızıltan B, Usta A. COVID-19 hastalığı ve hemşirelik bakımında örnek bir model: olgu sunumu. STED/Sürekli Tıp Eğitimi Dergisi. 2020;29(6):446- 55. doi: 10.17942/sted.804175
36. Breivik EK, Skoglund LA. Comparison of present pain intensity assessments on horizontally and vertically oriented visual analogue scales. Methods Find Exp Clin Pharmacol. 1998;20(8):719-24.
37. Doğru E, Yıldırım SA. Comparison of facial pain scale version of vertical and horizontal application which is used for pediatric. Turkiye Klinikleri J Pediatr. 2014;23(2):59-63.
38. McGrath PA, Seifert CE, Speechley KN, Booth JC, Stitt L, Gibson MC. A new analogue scale for assessing children’s pain: an initial validation study. Pain. 1996;64(3):435–43.
39. Wong DL, Baker CM. Pain in children: comparison of assessment scales. Pediatr Nurs 1988;14:9-17.
40. Wong-Baker FACES Foundation [İnternet]. Welcome to the Wong- Baker FACES Foundation; 2016 [cited 2021 Feb 10]. Erişim linki: https:// wongbakerfaces.org/
41. Merkel SI, Voepel-Lewis T, Shayevitz JR, Malviya S. The FLACC: a behavioral scale for scoring postoperative pain in young children. Pediatr Nurs. 1997;23:293–97.
42. Senayli Y, Ozkan F, Bicakci U. Evaluation of postoperative pain in children with FLACC pain scale in Turkish translation. Turkiye Klinikleri J Anest Reanim. 2006;4(1):1-4.
43. Lawrence J, Alcock D, McGrath P, Kay J, MacMurray SB, Dulberg C. The development of a tool to assess neonatal pain. Neonatal Netw. 1993;12(6):59-64.
44. Akdovan T. Sağlıklı Yenidoğanlarda Ağrının Değerlendirilmesi, Emzik Verme ve Kucağa Alma Yöntemlerinin Etkisinin İncelenmesi [Yüksek Lisans Tezi]. İstanbul: Marmara Üniversitesi Sağlık Bilimleri Enstitüsü, 1999. [Erişim tarihi: 1 Şubat 2021].
45. Stevens BJ, Gibbins S, Yamada J, Dionne K, Lee G, Johnston C, Taddio A. The premature infant pain profile-revised (PIPP-R): initial validation and feasibility. Clin J Pain. 2014;30:238-43.
46. Taplak AŞ, Bayat M. Psychometric Testing of the Turkish Version of the Premature Infant Pain Profile Revised-PIPP-R. J. Pediatr. Nurs. . 2019;48:e49-55. doi: 10.1016/j.pedn.2019.06.007.
47. Hand IL, Noble L, Geiss D, Wozniak L, Hall C. COVERS neonatal pain scale: development and validation. Int. J. Pediatr. 2010;496719:1-5.
48. Hummel P, Puchalski SD, Creech SD, Weiss MG. Clinical reliability and validity of the NPASS: neonatal pain, agitation and sedation scale with prolonged pain. Am. J. Perinatol. 2008;28(1):55-60.
49. Acikgoz A, Cigdem Z, Yildiz S, Demirustu C, Yarar M, Aksit A. A turkish adaptation of the neonatal pain/agitation, sedation scale (N-PASS) and its validity and reliability. Indian J Fundam Appl Life Sci. 2017;7:5-11.
50. Sen E, Manav G. Effect of Kangaroo care and oral sucrose on pain in premature infants: A randomized controlled trial. Pain Manag Nurs. . 2020;21(6):556-64. doi: 10.1016/j.pmn.2020.05.003.
51. Aydin D, İnal S. Effects of breastfeeding and heel warming on pain levels during heel stick in neonates. Int. J. Nurs. Pract. , 2019;25(3):e12734. doi: 10.1111/ijn.12734.
52. Erkul M, Efe E. Efficacy of breastfeeding on babies’ pain during vaccinations. Breastfeed Med. . 2017;12(2):110-5.
53. Çağlayan N, Balcı S. Preterm yenidoğanlarda ağrının azaltılmasında etkili bir yöntem: Cenin pozisyonu. FN Hem. Derg. 2014;22(1):63-8.
54. Erkut Z, Yildiz S. The effect of swaddling on pain, vital signs, and crying duration during heel lance in newborns. Pain Manag Nurs. . 2017;18(5):328-36.
55. Dur Ş, Çağlar S, Yıldız NU, Doğan P, Varal İG. The effect of yakson and gentle human touch methods on pain and physiological parameters in preterm infants during heel lancing. Intensive Crit. Care Nurs. . 2020;61:102886.
56. Harrison TM, Brown R, Duffey T, Frey C, Bailey J, Nist MD, et al. Effects of Massage on Postoperative Pain in Infants With Complex Congenital Heart Disease. Nurs. Res. 2020;69(5S):S36-46. doi: 10.1097/ NNR.0000000000000459.
57. Nimbalkar S, Shukla VV, Chauhan V, Phatak A, Patel D, Chapla, A, Nimbalkar A. Blinded randomized crossover trial: Skin-to-skin care vs. sucrose for preterm neonatal pain. J. Perinatol. . 2020;40(6):896-901. doi: 10.1038/s41372-020-0638-9.
58. Vu-Ngoc H, Uyen NCM, Thinh OP, Danh NVT, Truc NTT, Vi VT, et al. Analgesic effect of non-nutritive sucking in term neonates: A randomized controlled trial. Pediatrics & Neonatology. 2020;61(1):106-13. doi: 10.1016/j.pedneo.2019.07.003.
59. Azarmnejad E, Sarhangi F, Javadi M, Rejeh N. The effect of mother’s voice on arterial blood sampling induced pain in neonates hospitalized in neonate intensive care unit. Glob. J. Health Sci. . 2015;7(6):198. doi: 10.5539/gjhs.v7n6p198
60. Kahraman A, Gümüş M, Akar M, Sipahi M, Yılmaz HB, Başbakkal, Z. The effects of auditory interventions on pain and comfort in premature newborns in the neonatal intensive care unit; a randomised controlled trial. Intensive Crit. Care Nurs. 2020;61;102904. doi: 10.1016/j. iccn.2020.102904.
61. Rossi A, Molinaro A, Savi E, Micheletti S, Galli J, Chirico G, Fazzi E. Music reduces pain perception in healthy newborns: A comparison between different music tracks and recoded heartbeat. Early Hum. Dev. 2018;124:7-10. doi: 10.1016/j.earlhumdev.2018.07.006.
62. Bernstein K, Karkhaneh M, Zorzela L, Jou H, Vohra S. Massage therapy for paediatric procedural pain: A rapid review. Paediatrics & Child Health. 2021;26(1):e57-66. doi: 10.1093/pch/pxz133.
63. Aydin D, Sahiner NC. Effects of music therapy and distraction cards on pain relief during phlebotomy in children. Appl Nurs Res. 2017;33:164-8. doi: 10.1016/j.apnr.2016.11.011.
64. Bahadır Ö, Kürtüncü M. Müzik Terapinin 6-12 Yaş Arası Çocuklarda Anksiyete Ve Ağrı Yönetimine Etkisi: Randomize Kontrollü Bir Çalışma. Ege Üniversitesi Hemşirelik Fakültesi Dergisi. 2020;36(3):175-88.
65. Sayar S, Ergin D. Ortopedi Servisinde Yatan Çocuk Hastalarda Ameliyat Sonrası Ağrı Yönetiminde Müziğin Etkisinin İncelenmesi. Dokuz Eylül Üniversitesi Hemşirelik Fakültesi Elektronik Dergisi. 2019;12(1):67-73.
66. Godino-Iáñez MJ, Martos-Cabrera MB, Suleiman-Martos N, Gómez- Urquiza JL, Vargas-Román K, Membrive-Jiménez MJ, Albendín-García L. Play Therapy as an Intervention in Hospitalized Children: A Systematic Review. Healthcare. Multidisciplinary Digital Publishing Institute. 2020;8(3):239. doi: 10.3390/healthcare8030239.
67. Kıraner E, Terzi B, Yayık AK, Aydoğan S, Doğanay Ö, Yakut T, Kars DG. COVID-19 Pandemi Sürecinde Yoğun Bakım Hemşiresinin Rolü. İzmir Katip Çelebi Üniversitesi Sağlık Bilimleri Fakültesi Dergisi. 2021;6(1):45-8.
68. Al Mutair A, Amr A, Ambani Z, Salman KA, Schwebius D. Nursing surge capacity strategies for management of critically ill adults with COVID-19. Nurs. Rep. 2020;10(1):23-32. doi: 10.3390/nursrep10010004.