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Multidimensional 1-Year Outcomes After Intensive Care Admission for Multisystem Inflammatory Syndrome in Children
Thomas C Seijbel1, Levi Hoste2, Corinne M P Buysse1
1Department of Neonatal and Pediatric Intensive Care, Division of Pediatric Intensive Care, Erasmus MC Sophia Children's Hospital, Rotterdam, The Netherlands.
Insights
One year after pediatric intensive care unit (PICU) admission for Multisystem Inflammatory Syndrome in Children (MIS-C), most children showed normal functional performance. However, many experienced persistent physical and psychosocial sequelae impacting daily life.
Area of Science:
- Pediatric critical care medicine
- Infectious diseases
- Immunology
Background:
- The COVID-19 pandemic has raised concerns about long-term health effects following severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) infection.
- Multisystem Inflammatory Syndrome in Children (MIS-C) is a serious condition requiring pediatric intensive care unit (PICU) admission.
- Existing research often focuses on adults or single-domain sequelae in children.
Purpose of the Study:
- To investigate concurrent physical, cognitive, and psychosocial sequelae in children one year after PICU admission for MIS-C.
- To assess the long-term impact of MIS-C on children's functional performance and daily life.
Main Methods:
- Prospective cohort study conducted at two academic tertiary referral hospitals in the Netherlands and Belgium.
- In-person follow-up assessments were performed one year after PICU admission for MIS-C in pediatric patients (<18 years).
- Evaluated functional performance using validated scores (Pediatric Cerebral Performance Category, Pediatric Overall Performance Category, Functional Status Score) and assessed physical, cognitive, and psychosocial sequelae.
Main Results:
- Of 70 MIS-C patients admitted to the PICU, 58 (83%) attended the 1-year follow-up. Most admissions were due to circulatory failure, with common treatments including IV immunoglobulins and steroids.
- While most patients achieved normal functional performance scores, 62% reported physical sequelae such as fatigue (40%) and headaches (27%).
- Cognitive (14%), behavioral (13%), and psychological (23%) problems were also reported, leading to ongoing healthcare utilization (22%), difficulties returning to school (9%), and cessation of hobbies (7%).
Conclusions:
- This study provides the first comprehensive 1-year outcome assessment of MIS-C PICU patients, including physical and psychosocial domains.
- Despite normalized functional performance scores, a significant proportion of children experience multidimensional sequelae one year post-PICU admission, affecting their daily lives.
- Continued research and multidisciplinary follow-up programs are crucial for understanding MIS-C pathophysiology and developing targeted interventions to improve long-term outcomes and social participation.
Objectives:
The COVID-19 pandemic gave rise to uncertainty concerning potential sequelae related to a severe acute respiratory syndrome coronavirus 2 infection. This landscape is currently unfolding with studies reporting sequelae on various domains (physical, cognitive, and psychosocial), although most studies focus on adults or only one domain. We sought to investigate concurrent sequelae on multiple domains 1 year after PICU admission for Multisystem Inflammatory Syndrome in Children (MIS-C).
Design:
Prospective cohort study.
Setting:
Two academic, tertiary referral hospitals in The Netherlands and Belgium.
Patients:
Patients (< 18 yr, n = 58) seen in-person 1-year after PICU admission for MIS-C.
Interventions:
None.
Measurements And Main Results:
Seventy MIS-C patients (62% male; median age, 10.0 [interquartile range, 7.4-13.0]) were admitted to the PICU, mostly (86%) due to (imminent) circulatory failure. The majority received IV immunoglobulins (95%), steroids (83%), and vasopressors and/or inotropes (72%). Invasive respiratory support and extracorporeal membrane oxygenation were necessary in 7% and 2%, respectively. All patients survived. Fifty-eight patients (83%) attended 1-year follow-up. Although most patients had normal functional performance scores (Pediatric Cerebral Performance Category, Pediatric Overall Performance Category, and Functional Status Score), 62% still experienced physical sequelae: fatigue (40%), headaches (27%), and decreased exercise tolerance (19%). Cognitive, behavioral, and psychological problems were reported in 14%, 13%, and 23%, respectively. This resulted in 22% requiring ongoing healthcare utilization, 9% not being able to return to full-time school attendance and cessation of hobbies in 7%.
Conclusions:
This is the first 1-year outcome study of MIS-C PICU patients to include both physical and psychosocial characteristics. One year after PICU admission, most children had normalized functional performance as measured by three validated performance scores. However, many still reported a variety of multidimensional sequelae at 1-year follow-up impacting daily life. This emphasizes the importance of continued investigative efforts and multidisciplinary follow-up programs to better understand pathophysiology and contributing factors to the MIS-C disease trajectory and initiate patient-specific interventions to improve outcome and social participation.
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