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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

 

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