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COVID-19 Clinical Outcomes

Pediatric Inflammatory Multisystem Syndrome Following SARS-CoV-2: Outcomes at 6 Months

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BACKGROUND AND PURPOSE:

  • Some children infected with SARS-CoV-2 have experienced a rare post-infectious complication called pediatric inflammatory multisystem syndrome temporally associated with SARS-CoV-2 (PIMS-TS)
  • Penner et al. (The Lancet Child & Adolescent Health, 2021) described 6-month outcomes of PIMS-TS

METHODS:

  • Retrospective cohort study
  • Particpants
    • <18 years
    • Recent SARS-CoV-2 infection
    • Fulfilled UK Royal College of Pediatrics and Child Health (RCPCH) PIMS-TS criteria (see RCPCH Guidance for Clinicians in ‘Learn More – Primary Sources’ section below)
  • Study design
    • Patients seen in a PIMS-TS multidisciplinary outpatient clinic
    • Patients followed-up at 6 weeks and 6 months after admission
    • Biochemical and functional outcomes were analyzed

RESULTS:

  • 46 children | 65% male
    • Median age: 10.2 (IQR 8.8 to 13.3) years
    • Minority ethnic groups: 80% 
    • Pre-existing comorbidities: 17% 
  • No deaths reported
  • Most patients had severe multisystem involvement initially
    • Gastrointestinal: 98%
    • Neurological: 52%
    • Cardiac: 33%
  • All patients had elevated markers of systemic inflammation at baseline
    • By 6 months, systemic inflammation was resolved in all but one patient
  • Most findings were largely resolved by 6 months
    • Echocardiograms: Normal in 96% of patients by 6 months
    • Gastrointestinal symptoms: Present in 13% at 6 months
  • Neurological abnormalities were minor at 6 weeks and 6 months
    • 6 weeks: 52%
    • 6 months: 39%
    • Minimal functional impairment
    • Median Expanded Disability Status Scale score 0
  • Manual muscle test-8 scores improved between admission and 6 months
    • Muscle test score at admission: 53 (IQR 43–64)
    • Muscle test score at 6-months: 80 (IQR 68–80)
    • 45% of patients showed 6-min walk test results below the third centile for their age or sex at 6 months
  • Some patients had severe emotional difficulties at 6 months
    • Parental report: 18%
    • Self report: 22%
  • 98% of patients were back in full-time education (virtually or face to face) by 6 months
  • Of patients who had SARS-CoV-2 IgG antibodies at 6 weeks after admission, 90% remained seropositive at 6 months

CONCLUSION:

  • While illness was severe at admission, by 6 months, most organ-specific findings had resolved
  • There are ongoing concerns regarding physical conditioning and mental health
  • More follow-up is necessary to determine long-term effects of PIMS-TS

Learn More – Primary Sources:

6-month multidisciplinary follow-up and outcomes of patients with paediatric inflammatory multisystem syndrome (PIMS-TS) at a UK tertiary paediatric hospital: a retrospective cohort study

RCPCH: Paediatric multisystem inflammatory syndrome temporally associated with COVID-19 (PIMS) – guidance for clinicians

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Related ObG Topics:

Multisystem Inflammatory Syndrome in Children (MIS-C) and COVID-19
CDC Report on COVID-19 Cases in the US Pediatric Population
Multisystem Inflammatory Syndrome in Children Associated with COVID-19: Clinical Features and Outcomes

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