Multisystem Inflammatory Syndrome in Children Associated with Severe Acute Respiratory Syndrome Coronavirus 2 Infection (MIS-C): A Multi-institutional Study from New York City

J Pediatr. 2020 Sep;224:24-29. doi: 10.1016/j.jpeds.2020.06.045. Epub 2020 Jun 14.

Abstract

Objective: To assess clinical characteristics and outcomes of severe acute respiratory syndrome coronavirus 2-associated multisystem inflammatory syndrome in children (MIS-C).

Study design: Children with MIS-C admitted to pediatric intensive care units in New York City between April 23 and May 23, 2020, were included. Demographic and clinical data were collected.

Results: Of 33 children with MIS-C, the median age was 10 years; 61% were male; 45% were Hispanic/Latino; and 39% were black. Comorbidities were present in 45%. Fever (93%) and vomiting (69%) were the most common presenting symptoms. Depressed left ventricular ejection fraction was found in 63% of patients with median ejection fraction of 46.6% (IQR, 39.5-52.8). C-reactive protein, procalcitonin, d-dimer, and pro-B-type natriuretic peptide levels were elevated in all patients. For treatment, intravenous immunoglobulin was used in 18 (54%), corticosteroids in 17 (51%), tocilizumab in 12 (36%), remdesivir in 7 (21%), vasopressors in 17 (51%), mechanical ventilation in 5 (15%), extracorporeal membrane oxygenation in 1 (3%), and intra-aortic balloon pump in 1 (3%). The left ventricular ejection fraction normalized in 95% of those with a depressed ejection fraction. All patients were discharged home with median duration of pediatric intensive care unit stay of 4.7 days (IQR, 4-8 days) and a hospital stay of 7.8 days (IQR, 6.0-10.1 days). One patient (3%) died after withdrawal of care secondary to stroke while on extracorporeal membrane oxygenation.

Conclusions: Critically ill children with coronavirus disease-2019-associated MIS-C have a spectrum of severity broader than described previously but still require careful supportive intensive care. Rapid, complete clinical and myocardial recovery was almost universal.

Publication types

  • Multicenter Study
  • Observational Study

MeSH terms

  • Adolescent
  • Betacoronavirus
  • C-Reactive Protein / analysis
  • COVID-19
  • Child
  • Child, Preschool
  • Coronavirus Infections / complications*
  • Coronavirus Infections / drug therapy
  • Female
  • Fibrin Fibrinogen Degradation Products / analysis
  • Humans
  • Infant
  • Intensive Care Units, Pediatric
  • Male
  • Natriuretic Peptide, Brain / blood
  • New York City
  • Pandemics
  • Pneumonia, Viral / complications*
  • Procalcitonin / analysis
  • Retrospective Studies
  • SARS-CoV-2
  • Systemic Inflammatory Response Syndrome / diagnosis*
  • Systemic Inflammatory Response Syndrome / therapy
  • Treatment Outcome
  • Ventricular Function, Left
  • Young Adult

Substances

  • Fibrin Fibrinogen Degradation Products
  • Procalcitonin
  • fibrin fragment D
  • Natriuretic Peptide, Brain
  • C-Reactive Protein

Supplementary concepts

  • COVID-19 drug treatment
  • pediatric multisystem inflammatory disease, COVID-19 related