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Neurocognitive, Psychosocial, and Quality of Life Outcomes After Multisystem Inflammatory Syndrome in Children
Marieke H Otten1, Corinne M P Buysse2, Emmeline P Buddingh3
1Amsterdam UMC, University of Amsterdam, Emma Children's Hospital, Department of Pediatric Intensive Care, Amsterdam Reproduction and Development, Amsterdam, The Netherlands.
Insights
Children with Multisystem Inflammatory Syndrome in Children (MIS-C) show normal intelligence post-PICU but experience emotional and behavioral challenges, worse quality of life, and PTSD. Further investigation is needed to understand the causes of these neurocognitive impairments.
Area of Science:
- Pediatric critical care medicine
- Pediatric rheumatology
- Pediatric infectious diseases
Background:
- Multisystem Inflammatory Syndrome in Children (MIS-C) is a rare but serious condition following SARS-CoV-2 infection.
- Children with MIS-C often require Pediatric Intensive Care Unit (PICU) admission.
- Long-term neurocognitive, psychosocial, and quality of life (QoL) outcomes in these children are not well understood.
Purpose of the Study:
- To investigate neurocognitive, psychosocial, and QoL outcomes in children with MIS-C.
- To assess these outcomes 3-6 months after PICU admission.
- To compare outcomes with pre-COVID-19 general population norms.
Main Methods:
- Prospective cohort study conducted across seven PICUs in the Netherlands.
- Included children aged 0-17 years admitted to the PICU with MIS-C.
- Neurocognitive, psychosocial, and QoL assessments were performed at a median of 4 months post-PICU discharge.
Main Results:
- General intelligence and verbal memory were within normal limits compared to population norms.
- A significant subset of children exhibited deficits in visual memory, sustained attention, and planning.
- Children reported more emotional and behavioral problems, lower QoL (physical functioning, school functioning), increased fatigue, and elevated PTSD risk.
Conclusions:
- Children with MIS-C requiring PICU admission experience persistent neurocognitive, psychosocial, and QoL challenges despite normal overall intelligence.
- The findings highlight the need for comprehensive follow-up care for these children.
- The exact causes of these impairments (viral, inflammatory, PICU-related, or societal restrictions) require further investigation.
Objectives:
To investigate neurocognitive, psychosocial, and quality of life (QoL) outcomes in children with Multisystem Inflammatory Syndrome in Children (MIS-C) seen 3-6 months after PICU admission.
Design:
National prospective cohort study March 2020 to November 2021.
Setting:
Seven PICUs in the Netherlands.
Patients:
Children with MIS-C (0-17 yr) admitted to a PICU.
Interventions:
None.
Measurements And Main Results:
Children and/or parents were seen median (interquartile range [IQR] 4 mo [3-5 mo]) after PICU admission. Testing included assessment of neurocognitive, psychosocial, and QoL outcomes with reference to Dutch pre-COVID-19 general population norms. Effect sizes (Hedges' g ) were used to indicate the strengths and clinical relevance of differences: 0.2 small, 0.5 medium, and 0.8 and above large. Of 69 children with MIS-C, 49 (median age 11.6 yr [IQR 9.3-15.6 yr]) attended follow-up. General intelligence and verbal memory scores were normal compared with population norms. Twenty-nine of the 49 followed-up (59%) underwent extensive testing with worse function in domains such as visual memory, g = 1.0 (95% CI, 0.6-1.4), sustained attention, g = 2.0 (95% CI 1.4-2.4), and planning, g = 0.5 (95% CI, 0.1-0.9). The children also had more emotional and behavioral problems, g = 0.4 (95% CI 0.1-0.7), and had lower QoL scores in domains such as physical functioning g = 1.3 (95% CI 0.9-1.6), school functioning g = 1.1 (95% CI 0.7-1.4), and increased fatigue g = 0.5 (95% CI 0.1-0.9) compared with population norms. Elevated risk for posttraumatic stress disorder (PTSD) was seen in 10 of 30 children (33%) with MIS-C. Last, in the 32 parents, no elevated risk for PTSD was found.
Conclusions:
Children with MIS-C requiring PICU admission had normal overall intelligence 4 months after PICU discharge. Nevertheless, these children reported more emotional and behavioral problems, more PTSD, and worse QoL compared with general population norms. In a subset undergoing more extensive testing, we also identified irregularities in neurocognitive functions. Whether these impairments are caused by the viral or inflammatory response, the PICU admission, or COVID-19 restrictions remains to be investigated.
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