Retrospective evaluation of children diagnosed with myocarditis

Diagnosis and treatment of acute myocarditis in children can be challenging because it can present in many different forms and there are no widely accepted treatment protocols. In this study, it was aimed to examine the characteristics of pediatric myocarditis patients aged 0-18 years who applied to our hospital between January 2010 and September 2021, either as an outpatient or by referral. The characteristics of 127 patients included in the study were analyzed retrospectively. Length of hospital stay, length of stay in the intensive care unit (ICU), need for inotropes, need for invasive mechanical ventilation, development of arrhythmia, and death were determined as clinical outcome variables. It was determined that 51.6% of the patients needed ICU admission, 38.6% needed inotropes, and 17.5% needed invasive mechanical ventilation. In the follow-up after discharge, arrhythmia was detected in 8.7% of the patients. Mortality was found to be 3.1% during the first hospitalization period. 66.9% of the patients were male and 33.1% were female. The length of stay in the ICU was significantly longer in males and the need for inotropes was significantly higher in girls. It was observed that the number of patients increased toward the adolescence period. The younger age of the patient was found to be associated with poor clinical outcomes. It was found that admission with chest pain was associated with good clinical outcomes, and presentation with non-cardiac symptoms was associated with poor clinical outcomes. A history of oral rotavirus vaccine administration was found in two patients. 22% of the patients were identified as MISC myocarditis. There were abnormal findings in 75.5% of the admission ECGs. At admission, 32.1% of the patients had systolic failure. The admission left ventricular ejection fraction and shortening fractions were associated with clinical outcomes. There was no correlation between admission troponin I level and clinical outcomes. Elevated myoglobin, BNP and d-dimer levels, anemia, hypoalbuminemia and low monocytes count at admission found to be associated with severe disease and poor clinical outcomes. 90.7% of the cardiac magnetic resonance imaging of the patients were compatible with myocarditis. Intravenous immunoglobulin (IVIG) was given to 59.5% of the patients. There was no statistically significant effect of IVIG use on the change in troponin level and the improvement of ventricular functions. An increase in troponin does not appear to be a negative prognostic marker in myocarditis. On the other hand, in our study myoglobin, BNP, d-dimer, albumin, hemoglobin and monocyte count have been found to be suitable biomarkers that can be used to identify patients at risk for poor clinical outcomes in acute myocarditis. The effectiveness of IVIG use in myocarditis has not been demonstrated. The mainstay of myocarditis treatment is the heart failure treatment. The use of biomarkers in the diagnosis of myocarditis is also useful in identifying patients at risk for poor clinical outcomes.