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Pulmonary Sequelae of Severe Acute COVID-19 and Multisystem Inflammatory Syndrome (MIS-C) in Dutch Children

Lieke C E Noij1, Caroline L H Brackel2, Mariëlle W Pijnenburg3

  • 1Department of Pediatrics, Division of Pediatric Pulmonology and Allergy, Emma Children's Hospital, Amsterdam University Medical Center, University of Amsterdam, Amsterdam, the Netherlands.

Pediatric Pulmonology
|December 16, 2025
PubMed

Insights

Children hospitalized with COVID-19 or Multisystem Inflammatory Syndrome in Children (MIS-C) can experience long-term respiratory issues. COVID-19 survivors reported more symptoms and lower quality of life than MIS-C patients.

Area of Science:

  • Pediatric critical care medicine
  • Infectious disease epidemiology
  • Pulmonary rehabilitation

Background:

  • COVID-19 can cause severe respiratory illness or Multisystem Inflammatory Syndrome in Children (MIS-C), necessitating hospitalization.
  • Long-term health outcomes, particularly respiratory morbidity, following severe pediatric COVID-19 or MIS-C require further investigation.

Purpose of the Study:

  • To assess respiratory morbidity and health-related quality of life (HRQoL) in children 5-12 months post-hospitalization for MIS-C or COVID-19.
  • To compare the prevalence and nature of long-term symptoms between children who had MIS-C and those who had COVID-19.

Main Methods:

  • A multi-center, prospective cohort study involving children (0-17 years) hospitalized for MIS-C or COVID-19 in Dutch hospitals.
  • Follow-up assessments included clinical evaluation, HRQoL questionnaires, spirometry, and cardiopulmonary exercise testing (CPET).

Main Results:

  • 19% of 72 children reported persistent respiratory symptoms (dyspnea, cough) at a median of 8 months post-hospitalization.
  • Impaired HRQoL was more common in the COVID-19 group (60%) than the MIS-C group (14%).
  • Abnormal spirometry and CPET findings were noted in both groups, with higher rates in the COVID-19 cohort; deconditioning was a frequent CPET abnormality.

Conclusions:

  • Long-term respiratory sequelae and fatigue are potential outcomes of both MIS-C and severe COVID-19 in children.
  • Respiratory symptoms and reduced HRQoL were more prevalent following COVID-19 compared to MIS-C.
  • While COVID-19 related abnormalities often correlated with symptoms, MIS-C patients sometimes exhibited CPET changes without concurrent respiratory complaints or lung function deficits.
Abstract

Keywords:
MIS‐CPulmonary sequelaeacute COVID‐19children, cardiopulmonary exercise test (CPET)

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