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COVID-19 Clinical Outcomes

Multisystem Inflammatory Syndrome in Children Associated with COVID-19: Clinical Features and Outcomes

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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

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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

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