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J Pediatr Intensive Care
DOI: 10.1055/s-0043-1762910
Original Article

Recent Trends in Incidence and Outcomes for Acute Myocarditis in Children in the United States

Kalpana Singh 
1   Heart Center ICU, Children's Heart Institute, Children's Memorial Hermann Hospital, Houston, Texas, United States
2   University of Texas, Houston, Texas, United States
,
Riad Lutfi
3   Division of Critical Care Medicine, Riley Hospital for Children, Indianapolis, Indiana, United States
4   Indiana University, Indianapolis, Indiana, United States
,
John J. Parent
3   Division of Critical Care Medicine, Riley Hospital for Children, Indianapolis, Indiana, United States
4   Indiana University, Indianapolis, Indiana, United States
,
Colin Rogerson
3   Division of Critical Care Medicine, Riley Hospital for Children, Indianapolis, Indiana, United States
4   Indiana University, Indianapolis, Indiana, United States
,
Mouhammad Yabrodi
3   Division of Critical Care Medicine, Riley Hospital for Children, Indianapolis, Indiana, United States
4   Indiana University, Indianapolis, Indiana, United States
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Abstract

Lack of defined diagnostic criteria for acute myocarditis makes its diagnosis dependent on clinical suspicion. The objective of this study was to the current trends in demographics, clinical manifestations, treatments, and outcomes in the United States for children hospitalized with acute myocarditis. This retrospective study was conducted using data collected from the Pediatric Health Information System database for the years 2014 to 2020. We included patients 21 years of age or younger with acute myocarditis. The statistical analysis was performed using chi-squared test and continuous variables using Mann–Whitney's U-test for continuous data comparisons. We found 1,199 patients with acute myocarditis. About 60% of patients required admission to the intensive care unit (ICU). The median hospital length of stay was 4 days for all patients and 6 days for ICU patients. Two hundred sixty-five (22.1%) patients required invasive mechanical ventilation, 127 (10.6%) required extracorporeal membrane oxygenation, 33 (2.8%) required ventricular assist device, and 22 (1.8%) required cardiac transplantations. Milrinone was the most used vasoactive agent. The overall hospital mortality was 2.3%. Intravenous immunoglobulin (IVIG) infusion use decreased during the study period. On multivariate analysis, vasoactive medication use (p < 0.01) and arrhythmia (p = 0.02) were independently associated with increased odds of mortality. IVIG use (p = 0.01) was associated with decreased odds of mortality. Despite high morbidity and frequent need for advanced life support measures, the survival outcomes of acute myocarditis in children are favorable. Vasoactive medication support and occurrence of arrythmia were independently associated with mortality, most likely due to disease severity. Administration of IVIG was independently associated with reduced mortality. The Clinical trial registration is not applicable.

Keywords

myocarditis - children - incidence - outcome

Authors' Contribution

K.S. conceptualized and designed the study and protocol, collected and organized data, reviewed the data, drafted the initial manuscript, and reviewed and revised the manuscript. R.L. designed the study and protocol, reviewed the data, and reviewed and revised the manuscript. J.J.P. reviewed the data and reviewed and revised the manuscript. C.R. conceptualized and designed the study and protocol, coordinated and supervised data collection, reviewed the data, performed the data analyses, and reviewed and revised the manuscript. M.Y. conceptualized and designed the study and protocol, coordinated and supervised data collection, reviewed the data, and reviewed and revised the manuscript. All authors approved the final manuscript as submitted and agree to be accountable for all aspects of the work.




Publication History

Received: 07 November 2022

Accepted: 15 January 2023

Article published online:
15 March 2023

© 2023. Thieme. All rights reserved.

Georg Thieme Verlag KG
Rüdigerstraße 14, 70469 Stuttgart, Germany

 

  • References

  • 1 Tunuguntla H, Jeewa A, Denfield SW. Acute myocarditis and pericarditis in children. Pediatr Rev 2019; 40 (01) 14-25
    CrossrefPubMedGoogle Scholar
  • 2 Duncan BW, Bohn DJ, Atz AM, French JW, Laussen PC, Wessel DL. Mechanical circulatory support for the treatment of children with acute fulminant myocarditis. J Thorac Cardiovasc Surg 2001; 122 (03) 440-448
    CrossrefPubMedGoogle Scholar
  • 3 Ghelani SJ, Spaeder MC, Pastor W, Spurney CF, Klugman D. Demographics, trends, and outcomes in pediatric acute myocarditis in the United States, 2006 to 2011. Circ Cardiovasc Qual Outcomes 2012; 5 (05) 622-627
    CrossrefPubMedGoogle Scholar
  • 4 Othman HF, Byrnes J, Elsamny E, Hamzah M. Impact of ventricular arrhythmias on outcomes in children with myocarditis. Eur J Pediatr 2020; 179 (11) 1779-1786
    CrossrefPubMedGoogle Scholar
  • 5 Teele SA, Allan CK, Laussen PC, Newburger JW, Gauvreau K, Thiagarajan RR. Management and outcomes in pediatric patients presenting with acute fulminant myocarditis. J Pediatr 2011; 158 (04) 638-643.e1
    CrossrefPubMedGoogle Scholar
  • 6 Law YM, Lal AK, Chen S. et al; American Heart Association Pediatric Heart Failure and Transplantation Committee of the Council on Lifelong Congenital Heart Disease and Heart Health in the Young and Stroke Council. Diagnosis and management of myocarditis in children: a scientific statement from the American Heart Association. Circulation 2021; 144 (06) e123-e135
    PubMedGoogle Scholar
  • 7 Cooper LT, Baughman KL, Feldman AM. et al; American Heart Association, American College of Cardiology, European Society of Cardiology. The role of endomyocardial biopsy in the management of cardiovascular disease: a scientific statement from the American Heart Association, the American College of Cardiology, and the European Society of Cardiology. Circulation 2007; 116 (19) 2216-2233
    CrossrefPubMedGoogle Scholar
  • 8 Caforio ALP, Pankuweit S, Arbustini E. et al; European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Current state of knowledge on aetiology, diagnosis, management, and therapy of myocarditis: a position statement of the European Society of Cardiology Working Group on Myocardial and Pericardial Diseases. Eur Heart J 2013; 34 (33) 2636-2648 , 2648a–2648d
    CrossrefPubMedGoogle Scholar
  • 9 Saji T, Matsuura H, Hasegawa K. et al. Comparison of the clinical presentation, treatment, and outcome of fulminant and acute myocarditis in children. Circ J 2012; 76 (05) 1222-1228
    CrossrefPubMedGoogle Scholar
  • 10 RStudio _ Open source & professional software for data science teams - RStudio
    PubMed
  • 11 Wu MH, Wu ET, Wang CC. et al. Contemporary postnatal incidence of acquiring acute myocarditis by age 15 years and the outcomes from a nationwide birth cohort. Pediatr Crit Care Med 2017; 18 (12) 1153-1158
    CrossrefPubMedGoogle Scholar
  • 12 Wu HP, Lin MJ, Yang WC, Wu KH, Chen CY. Predictors of extracorporeal membrane oxygenation support for children with acute myocarditis. BioMed Res Int 2017; 2017: 2510695
    PubMedGoogle Scholar
  • 13 U.S. Census Bureau, 2016-2020 American Community Survey 5 year estimates. Table ID DPO5. ACS DEMOGRAPHIC AND HOUSING ESTIMATES
    PubMed
  • 14 Miyake CY, Teele SA, Chen L. et al. In-hospital arrhythmia development and outcomes in pediatric patients with acute myocarditis. Am J Cardiol 2014; 113 (03) 535-540
    CrossrefPubMedGoogle Scholar
  • 15 Matsuura H, Ichida F, Saji T. et al. Clinical features of acute and fulminant myocarditis in children – 2nd nationwide survey by Japanese society of pediatric cardiology and cardiac surgery. Circ J 2016; 80 (11) 2362-2368
    CrossrefPubMedGoogle Scholar
  • 16 Klugman D, Berger JT, Sable CA, He J, Khandelwal SG, Slonim AD. Pediatric patients hospitalized with myocarditis: a multi-institutional analysis. Pediatr Cardiol 2010; 31 (02) 222-228
    CrossrefPubMedGoogle Scholar
  • 17 Lee KJ, McCrindle BW, Bohn DJ. et al. Clinical outcomes of acute myocarditis in childhood. Heart 1999; 82 (02) 226-233
    CrossrefPubMedGoogle Scholar
  • 18 Prasad AN, Chaudhary S. Intravenous immunoglobulin in children with acute myocarditis and/or early dilated cardiomyopathy. Indian Pediatr 2014; 51 (07) 583-584
    CrossrefPubMedGoogle Scholar
  • 19 Kim HS, Sohn S, Park JY, Seo JW. Fulminant myocarditis successfully treated with high-dose immunoglobulin. Int J Cardiol 2004; 96 (03) 485-486
    CrossrefPubMedGoogle Scholar
  • 20 Drucker NA, Colan SD, Lewis AB. et al. γ-globulin treatment of acute myocarditis in the pediatric population. Circulation 1994; 89 (01) 252-257
    CrossrefPubMedGoogle Scholar
  • 21 Haque A, Bhatti S, Siddiqui FJ. Intravenous immune globulin for severe acute myocarditis in children. Indian Pediatr 2009; 46 (09) 810-811
    PubMedGoogle Scholar
  • 22 Atiq M, Hoda M, Aslam N. Effect of intravenous gamma globulin on short- and mid-term clinical outcome in acute viral myocarditis in children. World J Cardiovasc Dis 2014; 04 (02) 39-44
    CrossrefPubMedGoogle Scholar
  • 23 Lin MS, Tseng YH, Chen MY. et al. In-hospital and post-discharge outcomes of pediatric acute myocarditis underwent after high-dose steroid or intravenous immunoglobulin therapy. BMC Cardiovasc Disord 2019; 19 (01) 10
    CrossrefPubMedGoogle Scholar
  • 24 Isogai T, Yasunaga H, Matsui H, Tanaka H, Horiguchi H, Fushimi K. Effect of intravenous immunoglobulin for fulminant myocarditis on in-hospital mortality: propensity score analyses. J Card Fail 2015; 21 (05) 391-397
    CrossrefPubMedGoogle Scholar
  • 25 English RF, Janosky JE, Ettedgui JA, Webber SA. Outcomes for children with acute myocarditis. Cardiol Young 2004; 14 (05) 488-493
    CrossrefPubMedGoogle Scholar
  • 26 Robinson J, Hartling L, Vandermeer B, Sebastianski M, Klassen TP. Intravenous immunoglobulin for presumed viral myocarditis in children and adults. Cochrane Database Syst Rev 2020; 8 (08) CD004370
    PubMedGoogle Scholar