Multi-system inflammatory syndrome in children (MIS-C) associated with COVID-19 is a recently recognised potentially life-threatening entity. There is limited data on post-MIS-C sequelae. 21 children fulfilling the WHO criteria for MIS-C were included in our study. Data were collected at baseline and at 12-16 weeks post-discharge to look for any persistent sequelae mainly relating to the lungs or heart including coronary arteries. Fever was the most common presentation, found in 18 (85.7%) patients. All had a marked hyper-inflammatory state. Low ejection fraction (EF) was found in 10 (47.6%), but none had any coronary artery abnormality. All received corticosteroids, while 7 (33.3%) children required additional treatment with intravenous Immunoglobulins. 20 children improved while 1 left against medical advice. At discharge, 3 children had impaired left ventricular function. At median 15 weeks' follow-up, no persistent complications were found. EF had returned to normal and no coronary artery abnormalities were found during repeat echocardiography. Chest radiographs showed no fibrosis and all biochemical parameters had normalized. The children with MIS-C are extremely sick during the acute stage. Timely and adequate management led to full recovery without any sequelae at a median follow-up of 15 weeks. Keywords Follow-up • MIS-C • Multi-inflammatory syndrome • Outcomes • Paediatric COVID-19 Abbreviations MIS-C Multi-system inflammatory syndrome in children EF Ejection fraction KD Kawasaki disease PAI-1 Plasminogen activator inhibitor-1 CRP C-reactive protein LDH Lactate dehydrogenase LMWH Low molecular weight heparin Rheumatology INTERNATIONAL

Background: In developing countries, there is scarce data on paediatric critical care. This makes modification of practices to improve outcome, difficult. The above study was done to highlight the lack of facilities and concept of pediatric critical in the eastern part of India so that modification of management can lead to better outcome of critically ill children.Methods: A retrospective study of the demography, clinical profile, diagnosis, treatment and outcome of children admitted to the PICU of Kalinga Institute of Medical Sciences from January 2014 to December 2015 was done. Results: A total of 848 children were admitted to the PICU with male and female children being 61.3% and 38.7% respectively. Diagnoses included infectious diseases (20.7%), respiratory disease (19.1%), central nervous system diseases (14.3%), cardiovascular diseases (10.8%), gastrointestinal diseases (7%), surgical problems (4.7%) haematological (4%), renal (3.3%), poisonings (1.4%), and others (14.3%). Out of 848 admitted children, 4.1% died and (1.4%) left against medical advice (8.5%) children received mechanical ventilation, among which (62.5%) improved, 34.7% died and 2.8% children left against medical advice. Multiorgan dysfunction syndrome (MODS) and co-morbidity were present in 25% and 22% respectively. The proportion of death among patients admitted to PICU was 4.1%.Conclusions: The leading cause of admission was infectious and respiratory diseases. Children with MODS and co-morbidity had higher mortality. The overall mortality rate in our PICU was low. We conclude, a well-equipped intensive care unit with modern and innovative facilities leads to a good outcome.

No abstract

STRUCTURED ABSTRACTINTRODUCTIONFollowing an asymptomatic or mildly symptomatic Corona virus disease (COVID 19), otherwise healthy children, may develop serious manifestations in form of cardiac, neurological, respiratory, gastrointestinal and dermatologic dysfunction. Many such cases were being observed in Odisha, an eastern state of India and reported from different health care facilities. We related these unexplained serious manifestations to Multisystem Inflammatory Syndrome associated with COVID 19 (MIS-C) and planned this study.METHODSThis retrospective observational study was carried out in three tertiary care centres: Kalinga Institute of Medical Sciences, Bhubaneswar, MKCG Medical college Berhampur and Jagannath Hospital, Bhubaneswar between July to September of year 2020. Study population include all children from 1 month to 15 years admitted to hospital with MIS-C according to WHO Diagnostic Criteria. All the data were analyzed by SPSS.RESULTSA total of 21 children were included in our study. Maximum number of cases were male (76.2%), predominate age group was 6-10 yrs (47.6%). Predominate symptoms /signs in our observation were fever, pain abdomen, seizure and hypotension. Most of these cases were positive for SARS CoV antibody (80.95%). Response to immunotherapy was dramatic. Mortality (9%) of our study is higher to 1.8–3% from western literature. None of our patient had coronary abnormality while 2 had mild cardiac dysfunction at discharge comparable to other studies.CONCLUSIONMIS-C following exposure to COVID 19 infection in children is a clinical syndrome which needs early suspicion and appropriate intervention to prevent mortality.

No abstract