Short-term outcomes in children recovered from multisystem inflammatory syndrome associated with SARS-CoV-2 infection

Abstract

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

Validity of reported post-acute health outcomes in children with SARS-CoV-2 infection: a systematic review

“…Twelve studies were conducted in Europe 29-33,36,38-40,44,47,49 and 18 published in 2021 29-33,35-37,39-48 . Thirteen studies used data that were specifically collected for the purpose of the study 29,31-33,35-40,42,45,47,48 , 5 studies used routinely collected data 30,34,41,44,49 and the type of data was unclear in 2 studies 43,46 . Only 2 studies were registered 30,32 .…”

“…The other 3 controlled studies 30,33,34 had serious risk of bias because negative infection status was determined on the basis of having no documented COVID-19 diagnosis 30 or symptoms 33,34 regardless of laboratory virus detection. Risk of bias due to missing data was serious in 14 studies, because loss-to-follow-up was either>20% 29,31-34,37,39,40,42,43,48,49 or the information provided was unclear 35,38 . One study 41 reported following all participants but used multiple data sources without providing further details and was deemed to be of moderate risk of bias.…”

“…Twenty-one studies were eligible (Table 1; Supplementary material: eFigure1). Six studies had a control group [29][30][31][32][33][34] and 15 were uncontrolled [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] . Twelve studies were conducted in Europe [29][30][31][32][33]36,[38][39][40]44,47,49 and 18 published in 2021 [29][30][31][32][33][35][36][37][39][40][41][42][43][44][45][46][47]…”

“…Six studies had a control group [29][30][31][32][33][34] and 15 were uncontrolled [35][36][37][38][39][40][41][42][43][44][45][46][47][48][49] . Twelve studies were conducted in Europe [29][30][31][32][33]36,[38][39][40]44,47,49 and 18 published in 2021 [29][30][31][32][33][35][36][37][39][40][41][42][43][44][45][46][47][48] . Thirteen studies used data that were specifically collected for the purpose of the study …”

COVID-19 in Early Life: Infants and Children Are Affected Too

“…Treatment with anti-IL-6R and intravenous immunoglobulin (IVIG) rapidly normalized proinflammatory markers and resulted in good outcomes in a small cohort of patients, but these are not standard therapy (58). In another small cohort of 21 children, who met WHO criteria for MIS-C, all received corticosteroids, while 33% received IVIG (59).…”