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

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