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Six-Month Outcomes in Children With COVID-19 or Multisystem Inflammatory Syndrome in Children
Leigh M Howard1, James D Wilkinson1, Alexis Calvert1
1Department of Pediatrics, Monroe Carell Jr. Children's Hospital at Vanderbilt, Vanderbilt University Medical Center, Nashville, Tennessee.
Insights
Major complications from COVID-19 and MIS-C in children were infrequent at six months but occurred in those without prior health issues. Continued monitoring is vital for managing these severe pediatric SARS-CoV-2 infections.
Area of Science:
- Pediatric Infectious Diseases
- Critical Care Medicine
- Public Health
Background:
- Acute COVID-19 and multisystem inflammatory syndrome in children (MIS-C) can have long-term health consequences.
- Understanding the frequency and nature of major complications is crucial for pediatric patient management.
- Prospective follow-up studies are essential to characterize the sequelae of severe SARS-CoV-2 infection in youth.
Purpose of the Study:
- To determine the incidence of major cardiovascular, pulmonary, gastrointestinal/hepatic, renal, and neurologic complications at 6 months post-presentation.
- To compare complication rates between children hospitalized with acute COVID-19 and those with MIS-C.
- To identify risk factors and characteristics of children experiencing these complications.
Main Methods:
- Prospective cohort study (PRISM) involving 20 US pediatric academic medical centers.
- Enrolled individuals under 21 years with SARS-CoV-2 detection or meeting MIS-C criteria.
- Assessed major organ system complications at 6 months following initial presentation.
Main Results:
- Analyzed data from 229 hospitalized participants (59 COVID-19, 170 MIS-C).
- Major complications at 6 months: cardiovascular (8.2%), pulmonary (7.1%), gastrointestinal/hepatic (7.1%), renal (2.0%), and neurologic (1.6%).
- A significant proportion of participants with complications had no underlying medical conditions (42.9% COVID-19, 80.7% MIS-C).
Conclusions:
- Major complications following acute COVID-19 and MIS-C in children are infrequent but present.
- Complications were observed even in children without pre-existing medical conditions.
- Emphasizes the need for ongoing surveillance and management strategies for pediatric SARS-CoV-2 infections.
Objectives:
We aimed to characterize the frequency of major complications of acute COVID-19 and multisystem inflammatory syndrome in children (MIS-C) and adolescents present at 6 months after initial presentation.
Methods:
The Pediatric Research Immune Network on SARS-CoV-2 and MIS-C (PRISM) study was a prospective cohort at 20 US pediatric academic medical centers. Individuals aged younger than 21 years meeting any of the following were enrolled: SARS-CoV-2 detection within 7 days, Centers for Disease Control and Prevention (CDC) MIS-C criteria, or CDC MIS-C criteria except having involvement of 1 organ system. The study was designed to assess the proportion of children with major complications (cardiovascular, pulmonary, gastrointestinal/hepatic, renal, and/or neurologic) 6 months after presentation.
Results:
Data were analyzed on 229 hospitalized participants: 59 with COVID-19 (mean age 10.4 years; SD, 5.5) and 170 with MIS-C (mean age 10.1 years; SD, 4.8). Overall, 42.8% were female, making up 55.9% and 38.2% of the COVID-19 and MIS-C groups, respectively. Overall, the frequencies of major complications at 6 months after initial presentation were: 16/195 (8.2%) cardiovascular, 11/154 (7.1%) pulmonary, 11/154 (7.1%) gastrointestinal/hepatic, 3/152 (2.0%) renal, and 3/189 (1.6%) neurologic. Organ system complications did not differ significantly between the COVID-19 and MIS-C groups. Six of 14 (42.9%) COVID-19 and 21/26 (80.7%) MIS-C participants with at least 1 six-month complication had no underlying medical condition that may have been associated with their complication(s).
Conclusions:
Major complications were infrequent but observed in children without underlying medical conditions, underscoring the importance of prospective follow-up to optimize management and elucidate the complications associated with severe SARS-CoV-2 infection in children.
