BACKGROUND AND PURPOSE:

• Multisystem inflammatory syndrome in children (MIS-C) is a rare new syndrome in children and teens associated with COVID-19
• Feldstein et al. (NEJM, 2020) summarize the epidemiology and clinical characteristics of MIS-C in the US

METHODS:

• Prospective and retrospective surveillance of MIS-C patients
  • Overcoming COVID-19 study: CDC initiated surveillance for severe Covid-19 in children and adolescents
• Setting
  • Pediatric health centers across the U.S. from March 15 to May 20, 2020
• MIS-C cases defined as cases with all of the following criteria
  • Serious illness leading to hospitalization
  • Age of less than 21 years
  • Fever that lasted for at least 24 hours
  • Laboratory evidence of inflammation
  • Multisystem organ involvement
  • Evidence of infection with SARS-CoV-2 based on RT-PCR testing, antibody testing, or exposure to someone with COVID-19 in the past month

RESULTS:

• Total of 186 MIS-C patients | 26 states
  • Median age: 8.3 years
  • 62% male
  • Previously healthy: 73%
  • Positive for SARS-CoV-2 by RT-PCR or antibody: 70%
  • Hospitalized: 88%
• Organ system involvement
  • Gastrointestinal: 92% (171 patients)
  • Cardiovascular: 80% (149 patients)
  • Hematologic: 76% (142 patients)
  • Mucocutaneous: 74% (137 patients)
  • Respiratory: 70% (131 patients)
• Hospitalization
  • Median duration: 7 days (IQR 4 to 10 days)
  • ICU: 80% (148 patients)
  • Mechanical ventilation: 20% (37 patients)
  • Vasoactive support: 48% (90 patients)
  • 28% still hospitalized at time of report
• Mortality
  • Deaths: 2% (4 patients)
• Clinical features
  • Coronary-artery aneurysms: 8% (15 patients)
  • Kawasaki’s disease–like features: 40% (74 patients)
• Inflammation biomarkers
  • Elevations in ≥4 biomarkers: 92% (171 patients)
• Immunomodulating therapy use
  • IV immune globulin: 77% (144 patients)
  • Glucocorticoids: 49% (91 patients)
  • Interleukin-6 or 1RA inhibitors: 20% (38 patients)

CONCLUSION:

• MIS-C associated with COVID-19 can have serious clinical consequences
  • Most patients require ICU, and many receive mechanical ventilation
• Kawasaki’s disease-like features are common in MIS-C patients

Learn More – Primary Sources:

Multisystem Inflammatory Syndrome in U.S. Children and Adolescents

Related ObG Topics:

Hyperinflammatory Shock in Children and COVID-19

NEJM Correspondence: Clinical Course of COVID-19 in Children

Multisystem Inflammatory Syndrome in Children (MIS-C) and COVID-19