Multisystem Inflammatory Syndrome in Children in New York State

Abstract

Background: A multisystem inflammatory syndrome in children (MIS-C) is associated with coronavirus disease 2019. The New York State Department of Health (NYSDOH) established active, statewide surveillance to describe hospitalized patients with the syndrome.

Methods: Hospitals in New York State reported cases of Kawasaki's disease, toxic shock syndrome, myocarditis, and potential MIS-C in hospitalized patients younger than 21 years of age and sent medical records to the NYSDOH. We carried out descriptive analyses that summarized the clinical presentation, complications, and outcomes of patients who met the NYSDOH case definition for MIS-C between March 1 and May 10, 2020.

Results: As of May 10, 2020, a total of 191 potential cases were reported to the NYSDOH. Of 95 patients with confirmed MIS-C (laboratory-confirmed acute or recent severe acute respiratory syndrome coronavirus 2 [SARS-CoV-2] infection) and 4 with suspected MIS-C (met clinical and epidemiologic criteria), 53 (54%) were male; 31 of 78 (40%) were black, and 31 of 85 (36%) were Hispanic. A total of 31 patients (31%) were 0 to 5 years of age, 42 (42%) were 6 to 12 years of age, and 26 (26%) were 13 to 20 years of age. All presented with subjective fever or chills; 97% had tachycardia, 80% had gastrointestinal symptoms, 60% had rash, 56% had conjunctival injection, and 27% had mucosal changes. Elevated levels of C-reactive protein, d-dimer, and troponin were found in 100%, 91%, and 71% of the patients, respectively; 62% received vasopressor support, 53% had evidence of myocarditis, 80% were admitted to an intensive care unit, and 2 died. The median length of hospital stay was 6 days.

Conclusions: The emergence of multisystem inflammatory syndrome in children in New York State coincided with widespread SARS-CoV-2 transmission; this hyperinflammatory syndrome with dermatologic, mucocutaneous, and gastrointestinal manifestations was associated with cardiac dysfunction.

Figure 1. Syndrome Clusters According to Age Group among Patients with Multisystem Inflammatory Syndrome in Children (MIS-C).

Color ranges were determined at quintiles of the observed percentages. Dermatologic or mucocutaneous included the following symptoms: rash, conjunctivitis, swollen hands or feet, and mucosal changes. Gastrointestinal included the following symptoms: abdominal pain, nausea or vomiting, and diarrhea. Kawasaki’s disease (KD) or atypical KD was determined by discharge diagnosis or code in the International Classification of Diseases, 10th Revision (ICD-10). Myocarditis was determined by discharge diagnosis or ICD-10 code. Clinical myocarditis was defined as cardiac dysfunction on echocardiography with an elevated troponin level; if the troponin value was missing, clinical myocarditis was defined as an elevated level of pro–brain natriuretic peptide or brain natriuretic peptide and cardiac dysfunction or arrhythmia on electrocardiography in the context of an inflammatory process. Neurologic included the following symptoms: headache, altered mental status, and confusion.

Figure 2. Pediatric Cases of Coronavirus Disease 2019 (Covid-19) and of MIS-C.

All data are for patients younger than 21 years of age in New York State from March through May, 2020. Covid-19 was defined by a positive test for severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2).